Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Cresencz VA Medical Center, Philadelphia, PA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Am J Prev Med. 2024 Mar;66(3):399-407. doi: 10.1016/j.amepre.2023.11.002. Epub 2023 Dec 11.
The purpose of this study was to evaluate if an electronic health record (EHR) self-scheduling function was associated with changes in mammogram completion for primary care patients who were eligible for a screening mammogram using U.S. Preventive Service Task Force recommendations.
This was a retrospective cohort study (September 1, 2014-August 31, 2019, analyses completed in 2022) using a difference-in-differences design to examine mammogram completion before versus after the implementation of self-scheduling. The difference-in-differences estimate was the interaction between time (pre-versus post-implementation) and group (active EHR patient portal versus inactive EHR patient portal). The primary outcome was mammogram completion among all eligible patients, with completion defined as receiving a mammogram within 6 months post-visit. The secondary outcome was mammogram completion among patients who received a clinician order during their visit.
The primary analysis included 35,257 patient visits. The overall mammogram completion rate in the pre-period was 22.2% and 49.7% in the post-period. EHR self-scheduling was significantly associated with increased mammogram completion among those with an active EHR portal, relative to patients with an inactive portal (adjusted difference 13.2 percentage points [95% CI 10.6-15.8]). For patients who received a clinician mammogram order at their eligible visit, self-scheduling was significantly associated with increased mammogram completion among patients with an active EHR portal account (adjusted difference 14.7 percentage points, [95% CI 10.9-18.5]).
EHR-based self-scheduling was associated with a significant increase in mammogram completion among primary care patients. Self-scheduling can be a low-cost, scalable function for increasing preventive cancer screenings.
本研究旨在评估电子健康记录（EHR）自助预约功能是否与符合美国预防服务工作组建议进行筛查性乳房 X 光检查的初级保健患者的乳房 X 光检查完成率的变化有关。
这是一项回顾性队列研究（2014 年 9 月 1 日至 2019 年 8 月 31 日，分析于 2022 年完成），使用差异中的差异设计来检查实施自助预约前后的乳房 X 光检查完成情况。差异中的差异估计值是时间（实施前与实施后）与组（活动 EHR 患者门户与非活动 EHR 患者门户）之间的交互作用。主要结果是所有符合条件的患者中完成乳房 X 光检查的情况，完成定义为在就诊后 6 个月内接受乳房 X 光检查。次要结果是在就诊时收到临床医生医嘱的患者中完成乳房 X 光检查的情况。
主要分析包括 35257 次就诊。在预期间，整体乳房 X 光检查完成率为 22.2%，在后期为 49.7%。与使用非活动 EHR 门户的患者相比，EHR 自助预约与活动 EHR 门户患者的乳房 X 光检查完成率显著增加相关（调整后的差异为 13.2 个百分点[95%CI10.6-15.8]）。对于在符合条件的就诊时收到临床医生乳房 X 光检查医嘱的患者，EHR 自助预约与活动 EHR 门户患者中乳房 X 光检查完成率的增加显著相关（调整后的差异为 14.7 个百分点，[95%CI10.9-18.5]）。
基于 EHR 的自助预约与初级保健患者的乳房 X 光检查完成率显著增加有关。自助预约可以是一种低成本、可扩展的功能，用于增加预防癌症筛查。
