Ma Jessica E, Grubber Janet, Coffman Cynthia J, Wang Virginia, Hastings S Nicole, Allen Kelli D, Shepherd-Banigan Megan, Decosimo Kasey, Dadolf Joshua, Sullivan Caitlin, Sperber Nina R, Van Houtven Courtney H
Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, United States.
Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
JMIR Form Res. 2022 Jul 18;6(7):e35623. doi: 10.2196/35623.
Most efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and other unpaid caregivers.
Few health systems have implemented systematic processes for identifying caregivers. This study aimed to develop and evaluate an EHR-driven process for identifying veterans likely to have unpaid caregivers in a caregiver survey study. We additionally examined whether there were EHR-derived veteran characteristics associated with veterans having unpaid caregivers.
We selected EHR home- and community-based referrals suggestive of veterans' need for supportive care from friends or family. We identified veterans with these referrals across the 8 US Department of Veteran Affairs medical centers enrolled in our study. Phone calls to a subset of these veterans confirmed whether they had a caregiver, specifically an unpaid caregiver. We calculated the screening contact rate for unpaid caregivers of veterans using attempted phone screening and for those who completed phone screening. The veteran characteristics from the EHR were compared across referral and screening groups using descriptive statistics, and logistic regression was used to compare the likelihood of having an unpaid caregiver among veterans who completed phone screening.
During the study period, our EHR-driven process identified 12,212 veterans with home- and community-based referrals; 2134 (17.47%) veteran households were called for phone screening. Among the 2134 veterans called, 1367 (64.06%) answered the call, and 813 (38.1%) veterans had a caregiver based on self-report of the veteran, their caregiver, or another person in the household. The unpaid caregiver identification rate was 38.1% and 59.5% among those with an attempted phone screening and completed phone screening, respectively. Veterans had increased odds of having an unpaid caregiver if they were married (adjusted odds ratio [OR] 2.69, 95% CI 1.68-4.34), had respite care (adjusted OR 2.17, 95% CI 1.41-3.41), or had adult day health care (adjusted OR 3.69, 95% CI 1.60-10.00). Veterans with a dementia diagnosis (adjusted OR 1.37, 95% CI 1.00-1.89) or veteran-directed care referral (adjusted OR 1.95, 95% CI 0.97-4.20) were also suggestive of an association with having an unpaid caregiver.
The EHR-driven process to identify veterans likely to have unpaid caregivers is systematic and resource intensive. Approximately 60% (813/1367) of veterans who were successfully screened had unpaid caregivers. In the absence of discrete fields in the EHR, our EHR-driven process can be used to identify unpaid caregivers; however, incorporating caregiver identification fields into the EHR would support a more efficient and systematic identification of caregivers.
ClincalTrials.gov NCT03474380; https://clinicaltrials.gov/ct2/show/NCT03474380.
大多数为研究确定照料者的工作采用自我提名等被动方法。我们描述了一种方法，即电子健康记录（EHR）可有助于确定、招募并增加家庭照料者和其他无薪照料者的多样化代表性。
很少有卫生系统实施过确定照料者的系统流程。本研究旨在开发并评估一种由EHR驱动的流程，用于在一项照料者调查研究中确定可能有无薪照料者的退伍军人。我们还研究了是否存在源自EHR的与有无薪照料者的退伍军人相关的退伍军人特征。
我们从EHR中选择了基于家庭和社区的转诊信息，这些信息表明退伍军人需要朋友或家人的支持性护理。我们在参与我们研究的8家美国退伍军人事务部医疗中心中确定了有这些转诊信息的退伍军人。对这些退伍军人中的一部分进行电话随访，以确认他们是否有照料者，特别是无薪照料者。我们计算了对退伍军人的无薪照料者进行电话筛查尝试者和完成电话筛查者的筛查联系率。使用描述性统计方法比较了转诊组和筛查组中源自EHR的退伍军人特征，并使用逻辑回归比较了完成电话筛查的退伍军人中有无薪照料者的可能性。
在研究期间，我们由EHR驱动的流程确定了12212名有基于家庭和社区转诊信息的退伍军人；2134个（17.47%）退伍军人家庭被电话联系进行筛查。在被联系的2134名退伍军人中，1367名（64.06%）接听了电话，并且根据退伍军人、其照料者或家庭中的另一人的自我报告，813名（38.1%）退伍军人有照料者。在进行电话筛查尝试者和完成电话筛查者中，无薪照料者识别率分别为38.1%和59.5%。如果退伍军人已婚（调整优势比[OR] 2.69，95%置信区间1.68 - 4.34）、接受临时护理（调整OR 2.17，95%置信区间1.41 - 3.41）或接受成人日间保健（调整OR 3.69，95%置信区间1.60 - 10.00），则他们有无薪照料者的几率增加。患有痴呆症诊断的退伍军人（调整OR 1.37，95%置信区间1.00 - 1.89）或接受退伍军人主导护理转诊的退伍军人（调整OR 1.95，95%置信区间0.97 - 4.20）也提示与有无薪照料者有关联。
由EHR驱动的确定可能有无薪照料者的退伍军人的流程是系统的且资源密集。成功筛查的退伍军人中约60%（813/1367）有无薪照料者。在EHR中没有离散字段的情况下，我们由EHR驱动的流程可用于确定无薪照料者；然而，将照料者识别字段纳入EHR将支持更高效和系统地识别照料者。
ClinicalTrials.gov NCT03474380；https://clinicaltrials.gov/ct2/show/NCT03474380 。
