From the Institute for Community Health, Malden, MA (LZ, LC, ST); Cambridge Health Alliance, Cambridge, MA (LZ, SD, AS); Harvard Medical School, Boston, MA (LZ, AS); Tufts University School of Medicine, Boston, MA (WA); University of New England, Biddeford, ME (KR).
J Am Board Fam Med. 2021 Jan-Feb;34(1):70-77. doi: 10.3122/jabfm.2021.01.200330.
Medical scribes are charged with decreasing documentation burden associated with patient visits. Reducing time spent on documentation may afford providers the opportunity to respond to out-of-visit inbox tasks faster.
We compare changes in the time taken to address patient portal messages, prescription requests, and test results from before to after scribe implementation among scribed primary care providers (PCPs), compared with nonscribed PCPs during the same time period. We used generalized estimating equations with robust standard errors to account for repeated measures and the hierarchical nature of the data, and adjusted for provider and patient characteristics.
We examined 472,411 tasks, including 27,645 tasks for 5 scribed PCPs and 444,766 tasks of 74 nonscribed PCPs. In unadjusted analyses, we found no change in time to completion for prescription refill requests, results and patient portal messages; the change in time to completion from pre to post intervention among scribed PCPs was 1.02 times that of nonscribed providers ( = .585) for prescription refill requests, 1.06 times that of nonscribed providers ( = .516) for patient portal messages, and 1.02 times that of nonscribed providers ( = .787) for results. Adjustment for provider and patient characteristics did not change these findings.
Our study suggests that scribes are not associated with improved time to completion of inbox messages for PCPs. While scribes seem to have many benefits, our study suggests they may not improve time to completion of out-of-visit tasks. Reducing the time to completion for these tasks likely requires other interventions targeted to achieve those outcomes.
医疗抄写员的职责是减少与患者就诊相关的文件记录负担。减少文档记录所花费的时间可以让医疗服务提供者有更多的机会更快地回复门诊任务。
我们比较了在实施抄写员前后，抄写员初级保健医生（PCP）与同期未抄写员 PCP 相比，处理患者门户信息、处方请求和测试结果的时间变化。我们使用广义估计方程和稳健标准误差来考虑重复测量和数据的层次结构，并根据提供者和患者的特征进行调整。
我们共检查了 472411 项任务，其中包括 5 名抄写员 PCP 的 27645 项任务和 74 名未抄写员 PCP 的 444766 项任务。在未调整的分析中，我们发现处方续方请求、结果和患者门户信息的完成时间没有变化；与非抄写员相比，抄写员 PCP 从干预前到干预后的完成时间变化是处方续方请求的 1.02 倍（ = .585），患者门户消息的 1.06 倍（ = .516），结果的 1.02 倍（ = .787）。调整提供者和患者特征并没有改变这些发现。
我们的研究表明，抄写员与 PCP 完成收件箱信息的时间缩短无关。虽然抄写员似乎有很多好处，但我们的研究表明，他们可能无法缩短门诊任务的完成时间。要缩短这些任务的完成时间，可能需要采取其他针对这些结果的干预措施。
