Guzman Adriana, Brown Tiffany, Liss David T
Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Mhealth. 2022 Apr 20;8:13. doi: 10.21037/mhealth-21-49. eCollection 2022.
Despite the broad adoption of electronic health records (EHRs) for inpatient and outpatient care, and wide availability of EHR-linked portals, these tools are not always effective in informing primary care teams about patients' emergency department (ED) visits or inpatient admissions, leading to persistent gaps in care coordination. The objective of this study was to understand how patients with limited patient portal use in a safety net setting engaged with a smartphone app that used location tracking to detect and notify care teams about patients' hospital use in order to stimulate care coordination and follow-up care.
We recruited English- and Spanish-speaking adults at high risk of hospital use from a Federally Qualified Health Center (FQHC). The app detected when patients visited the hospital and asked them to confirm a hospital visit. When confirmed, the app notified the primary care team about the visit, and the care team followed up with patients according to the FQHC protocols for care coordination. We collected qualitative data on app experience from participants who used the app for four months and used a general inductive approach to identify recurring themes.
Participants generally reported a positive app experience, as it helped solve the problem of poor follow-up care. "I liked the goal of the app…Ultimate goal of it was comforting", recounted one participant when describing her app experience. Participants thought the app push notifications could be refined and the app itself could be modernized. Participants also suggested improvements to the push notifications they received from the app and the visit information they entered into the app for care teams to receive. Some participants also suggested improvements to the FQHC's care coordination workflows facilitated by the app, like an immediate connection to the patient's primary care team.
The app was well received by low-income patients at high risk of ED/inpatient visits. Future research is needed to determine feasibility of implementation in other settings.
尽管电子健康记录（EHRs）已广泛应用于住院和门诊护理，且与EHR相关的门户广泛可用，但这些工具在向基层医疗团队通报患者的急诊科（ED）就诊或住院情况时并不总是有效，导致护理协调方面持续存在差距。本研究的目的是了解在安全网环境中患者门户使用受限的患者如何使用一款智能手机应用程序，该应用程序利用位置跟踪来检测并通知护理团队患者的住院情况，以促进护理协调和后续护理。
我们从一家联邦合格健康中心（FQHC）招募了有高住院风险的讲英语和西班牙语的成年人。该应用程序在检测到患者前往医院时，会要求他们确认就诊情况。确认后，应用程序会将就诊情况通知基层医疗团队，护理团队会根据FQHC的护理协调协议对患者进行随访。我们收集了使用该应用程序四个月的参与者关于应用程序体验的定性数据，并采用一般归纳法来识别反复出现的主题。
参与者普遍报告了积极的应用程序体验，因为它有助于解决后续护理不佳的问题。一位参与者在描述她的应用程序体验时说：“我喜欢这个应用程序的目标……它的最终目标让人安心。”参与者认为应用程序的推送通知可以改进，应用程序本身也可以进行现代化改进。参与者还建议改进他们从应用程序收到的推送通知以及他们为护理团队输入的就诊信息。一些参与者还建议改进由该应用程序促进的FQHC的护理协调工作流程，比如直接与患者的基层医疗团队建立联系。
该应用程序受到了有高急诊/住院就诊风险的低收入患者的好评。未来需要进行研究以确定在其他环境中实施的可行性。
