Franzosa Emily, Traylor Morgan, Judon Kimberly M, Guerrero Aquino Vivian, Schwartzkopf Ashley L, Boockvar Kenneth S, Dixon Brian E
Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Am Med Inform Assoc. 2021 Jul 30;28(8):1728-1735. doi: 10.1093/jamia/ocab074.
To assess primary care teams' perceptions of a health information exchange (HIE) event notification intervention for geriatric patients in 2 Veterans Health Administration (VHA) medical centers.
We conducted a qualitative evaluation of an event notification alerting primary care teams to non-VHA hospital admissions and emergency department visits. Data were collected through semistructured interviews (n = 23) of primary care team physicians, nurses and medical assistants. Study design and analysis were guided by the Consolidated Framework for Implementation Research (CFIR).
Team members found the alerts necessary, helpful for filling information gaps, and effective in supporting timely follow-up care, although some expressed concern over scheduling capacity and distinguishing alerts from other VHA notices. Participants also suggested improvements including additional data on patients' diagnosis and discharge instructions, timing alerts to patients' discharge (including clear next steps), including additional team members to ensure alerts were acted upon, and implementing a single sign-on.
Primary care team members perceived timely event notification of non-VHA emergency department visits and hospital admissions as potentially improving post-discharge follow-up and patient outcomes. However, they were sometimes unsure of next steps and suggested the alerts and platform could be streamlined for easier use.
Event notifications may be a valuable tool in coordinating care for high-risk older patients. Future intervention research should explore the optimal amount and types of information and delivery method across sites and test the integration of alerts into broader care coordination efforts.
评估两个退伍军人健康管理局（VHA）医疗中心的基层医疗团队对老年患者健康信息交换（HIE）事件通知干预措施的看法。
我们对一项事件通知进行了定性评估，该通知可提醒基层医疗团队关注非VHA医院的住院情况和急诊科就诊情况。通过对基层医疗团队的医生、护士和医疗助理进行半结构化访谈（n = 23）收集数据。研究设计和分析以实施研究综合框架（CFIR）为指导。
团队成员认为这些警报是必要的，有助于填补信息空白，并能有效地支持及时的后续护理，尽管一些人对安排能力以及将警报与其他VHA通知区分开来表示担忧。参与者还提出了改进建议，包括提供有关患者诊断和出院指导的更多数据、在患者出院时发送警报（包括明确的后续步骤）、增加团队成员以确保对警报采取行动，以及实施单点登录。
基层医疗团队成员认为，及时通知非VHA急诊科就诊和住院事件可能会改善出院后的随访情况和患者预后。然而，他们有时不确定后续步骤，并建议简化警报和平台以便于使用。
事件通知可能是协调高危老年患者护理的一个有价值的工具。未来的干预研究应探索不同地点的最佳信息量、信息类型和传递方式，并测试将警报整合到更广泛的护理协调工作中的效果。
