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医疗抄写员对 COVID-19 大流行之前及期间门诊放射肿瘤学诊所医生效率的影响。

Medical Scribe Impact on Provider Efficiency in Outpatient Radiation Oncology Clinics Before and During the COVID-19 Pandemic.

作者信息

Devine Max, Wang Elyn, von Eyben Rie, Bagshaw Hilary P

机构信息

Department of Radiation Oncology, Stanford University, Stanford, California, USA.

出版信息

Telemed Rep. 2022 Jan 7;3(1):1-6. doi: 10.1089/tmr.2021.0035. eCollection 2022.

Abstract

Medical documentation has become increasingly challenging for providers, particularly with changes to telemedicine visit formats during the ongoing COVID-19 pandemic. Medical scribes may help mitigate this burden. Our objective was to determine how scribes affect provider efficiency during the COVID-19 pandemic. Providers completed a survey in February 2020 (S1, prepandemic) and 1 year into the COVID-19 pandemic in February 2021 (S2, during pandemic). S1 evaluated perceived impact of scribes on clerical work, medical documentation, and efficiency during office visits using the Likert scale. S2 also addressed scribe use during telemedicine visits. Provider time spent on documentation with or without a scribe was evaluated using a five-level ordinal scale. Provider response was assessed using descriptive frequency statistics. Fisher's exact test was used to compare categorical variables. Analysis was performed using SAS version 9.4 (SAS Institute, Inc., Cary, NC). All tests were two sided with an alpha level of 0.05. Fifty-eight providers responded to the surveys: 36 (62%) for S1 and 22 (38%) for S2. Scribe use decreased perceived clerical work and facilitated chart review, and recording of physical examination findings, note documentation, and improved efficiency, both before and during the pandemic ( = 0.5,  = 0.7,  = 0.8,  = 0.8,  = 0.9, respectively). Scribe use significantly decreased time to complete documentation prepandemic ( = 0.002) and during the pandemic for both in-person ( ≤ 0.0001) and telemedicine visits ( = 0.0004). More providers took >60 min to complete medical documentation without the use of a scribe prepandemic (72% vs. 30% with a scribe,  = 0.006) and during the pandemic, after both in-person (40% vs. 0% with a scribe,  = 0.002) and telemedicine visits (35% vs. 0% with a scribe,  = 0.002). Scribe use decreases provider time spent on medical documentation and improves overall efficiency before and during the COVID-19 pandemic for both in-person and telemedicine visits. Integration of scribes into radiation oncology in-person and telemedicine clinics may improve provider satisfaction by reducing burden of documentation.

摘要

对于医疗服务提供者而言,医疗文档记录工作变得越来越具有挑战性,尤其是在当前新冠疫情期间远程医疗就诊形式发生变化的情况下。医疗抄写员可能有助于减轻这一负担。我们的目标是确定抄写员在新冠疫情期间如何影响医疗服务提供者的效率。医疗服务提供者在2020年2月(S1,疫情前)和2021年2月新冠疫情爆发1年后(S2,疫情期间)完成了一项调查。S1使用李克特量表评估了抄写员对门诊期间文书工作、医疗文档记录和效率的感知影响。S2还涉及了远程医疗就诊期间抄写员的使用情况。使用五级有序量表评估有或没有抄写员时医疗服务提供者花费在文档记录上的时间。使用描述性频率统计评估医疗服务提供者的回复。使用费舍尔精确检验比较分类变量。使用SAS 9.4版本(SAS Institute, Inc., Cary, NC)进行分析。所有检验均为双侧检验,显著性水平为0.05。58名医疗服务提供者回复了调查:S1有36名(62%),S2有22名(38%)。在疫情之前和期间,使用抄写员都减少了感知到的文书工作,便于病历审查、体格检查结果记录、笔记记录,并提高了效率(分别为=0.5,=0.7,=0.8,=0.8,=0.9)。使用抄写员显著减少了疫情前(=0.002)以及疫情期间面对面就诊(≤0.0001)和远程医疗就诊(=0.0004)时完成文档记录的时间。在疫情之前,更多医疗服务提供者在不使用抄写员的情况下需要超过60分钟来完成医疗文档记录(72%对比使用抄写员时的30%,=0.006),在疫情期间,面对面就诊后(40%对比使用抄写员时的0%,=0.002)以及远程医疗就诊后(35%对比使用抄写员时的0%,=0.002)也是如此。在新冠疫情之前和期间,无论是面对面就诊还是远程医疗就诊时,使用抄写员都减少了医疗服务提供者花费在医疗文档记录上的时间并提高了整体效率。将抄写员纳入放射肿瘤学的面对面和远程医疗诊所可能会通过减轻文档记录负担来提高医疗服务提供者的满意度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c71/8989091/e2415faeb00d/tmr.2021.0035_figure1.jpg

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