Micek Mark A, Arndt Brian, Baltus Jeffrey J, Broman Aimee Teo, Galang Joel, Dean Shannon, Anderson Matthew, Sinsky Christine
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Healthc (Amst). 2022 Dec;10(4):100663. doi: 10.1016/j.hjdsi.2022.100663. Epub 2022 Nov 12.
Physician burnout is a major problem in the United States. Small studies suggest scribes can improve clinician satisfaction, but scribe programs have not been evaluated using separate control groups or structured measures of electronic health record (EHR) use.
We conducted a pre-post, non-randomized controlled evaluation of a remote scribe pilot program introduced in September 2019 in an academic primary care practice. Scribes were paired with physicians via an audio-only cellphone connection to hear and document in real-time. Physician wellness was measured with the 10-item Mini-Z and 16-item Professional Fulfillment Index. EHR use was measured using vendor-derived platforms that provide routine EHR-related data.
37 of 38 scribe users (97.4%) and 68 of 160 potential control physicians (42.5%) completed both pre and post intervention questionnaires. Compared with controls, scribe users had improvements in Mini-Z wellness metrics including Joyful Workplace (mean improvement 2.83, 95%CI 0.60, 5.06) and a single-item dichotomized burnout measure (OR 0.15, 95%CI 0.03, 0.71). There were significant reductions among scribe users compared to controls in total EHR time per 8 scheduled hours (-1.14 h, 95%CI -1.55, -0.72), and an increase in the percentage of orders with team contribution (10.4%, 95%CI 5.2, 15.6). These findings remained significant in adjusted analyses.
CONCLUSIONS/IMPLICATIONS: A remote scribe program was associated with improvements in physician wellness and reduced EHR use. Healthcare organizations can consider scribe programs to help improve wellness among their physician workforce.
医生职业倦怠是美国的一个主要问题。小型研究表明，抄写员可以提高临床医生的满意度，但尚未使用单独的对照组或电子健康记录（EHR）使用的结构化测量方法对抄写员项目进行评估。
我们对2019年9月在一家学术性初级保健机构引入的远程抄写员试点项目进行了前后非随机对照评估。抄写员通过仅音频的手机连接与医生配对，以便实时听取和记录。使用10项Mini-Z和16项职业成就感指数来测量医生的健康状况。使用提供常规EHR相关数据的供应商衍生平台来测量EHR的使用情况。
38名抄写员用户中的37名（97.4%）和160名潜在对照医生中的68名（42.5%）完成了干预前和干预后的问卷。与对照组相比，抄写员用户在Mini-Z健康指标方面有所改善，包括快乐工作场所（平均改善2.83，95%CI 0.60，5.06）和一项单项二分法职业倦怠测量指标（OR 0.15，95%CI 0.03，0.71）。与对照组相比，抄写员用户每8个预定小时的EHR总时间显著减少（-1.14小时，95%CI -1.55，-0.72），团队贡献的医嘱百分比增加（10.4%，95%CI 5.2，15.6）。在调整分析中，这些发现仍然显著。
结论/启示：远程抄写员项目与医生健康状况的改善和EHR使用的减少有关。医疗保健组织可以考虑采用抄写员项目来帮助改善其医生队伍的健康状况。
