利用健康信息交换平台来检验住院受伤幸存者自我报告的急诊科使用数据的准确性。
Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors.
作者信息
Whiteside Lauren K, Vrablik Marie C, Russo Joan, Bulger Eileen M, Nehra Deepika, Moloney Kathleen, Zatzick Douglas F
机构信息
Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
出版信息
Trauma Surg Acute Care Open. 2021 Jan 28;6(1):e000550. doi: 10.1136/tsaco-2020-000550. eCollection 2021.
BACKGROUND
Accurate acute care medical utilization history is an important outcome for clinicians and investigators concerned with improving trauma center care. The objective of this study was to examine the accuracy of self-report emergency department (ED) utilization compared with utilization obtained from the Emergency Department Information Exchange (EDIE) in admitted trauma surgery patients with comorbid mental health and substance use problems.
METHODS
This is a retrospective cohort study of 169 injured patients admitted to the University of Washington's Harborview Level I Trauma Center. Patients had high levels of post-traumatic stress disorder and depressive symptoms, suicidal ideation and alcohol comorbidity. The investigation used EDIE, a novel health technology tool that collects information at the time a patient checks into any ED in Washington and other US states. Patterns of EDIE-documented visits were described, and the accuracy of injured patients' self-report visits was compared with EDIE-recorded visits during the course of the 12 months prior to the index trauma center admission.
RESULTS
Overall, 45% of the sample (n=76) inaccurately recalled their ED visits during the past year, with 36 participants (21%) reporting less ED visits than EDIE indicated and 40 (24%) reporting more ED visits than EDIE indicated. Patients with histories of alcohol use problems and major psychiatric illness were more likely to either under-report or over-report ED health service use.
DISCUSSION
Nearly half of all patients were unable to accurately recall ED visits in the previous 12 months compared with EDIE, with almost one-quarter of patients demonstrating high levels of disagreement. The improved accuracy and ease of use when compared with self-report make EDIE an important tool for both clinical and pragmatic trial longitudinal outcome assessments. Orchestrated investigative and policy efforts could further examine the benefits of introducing EDIE and other information exchanges into routine acute care clinical workflows.
LEVEL OF EVIDENCE
II/III.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov NCT02274688.
背景
准确的急性护理医疗利用史是关注改善创伤中心护理的临床医生和研究人员的一项重要成果。本研究的目的是比较合并有心理健康和物质使用问题的创伤外科住院患者自我报告的急诊科（ED）就诊情况与通过急诊科信息交换（EDIE）获取的就诊情况的准确性。
方法
这是一项对169名入住华盛顿大学哈博维尤一级创伤中心的受伤患者进行的回顾性队列研究。患者有高水平的创伤后应激障碍和抑郁症状、自杀意念以及酒精合并症。该研究使用了EDIE，这是一种新型健康技术工具，可在患者入住华盛顿州和美国其他州的任何急诊科时收集信息。描述了EDIE记录的就诊模式，并将受伤患者自我报告就诊的准确性与指数创伤中心入院前12个月期间EDIE记录的就诊情况进行了比较。
结果
总体而言，45%的样本（n = 76）在过去一年中不准确地回忆了他们的急诊科就诊情况，36名参与者（21%）报告的急诊科就诊次数少于EDIE显示的次数，40名（24%）报告的就诊次数多于EDIE显示的次数。有酒精使用问题和重度精神疾病病史的患者更有可能少报或多报急诊科医疗服务的使用情况。
讨论
与EDIE相比，近一半的患者无法准确回忆前12个月的急诊科就诊情况，近四分之一的患者表现出高度不一致。与自我报告相比，EDIE提高了准确性且使用更简便，使其成为临床和实用试验纵向结果评估的重要工具。精心策划的调查和政策努力可以进一步研究将EDIE和其他信息交换引入常规急性护理临床工作流程的益处。
证据水平
II/III。
试验注册号
ClinicalTrials.gov NCT02274688。
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