Lum Hillary D, Cassidy Jessica, Lin Chen-Tan, DesRoches Catherine M, Shanbhag Prajakta, Gleason Kelly T, Powell Danielle S, Peereboom Danielle, Riffin Catherine A, Smith Jamie M, Wec Aleksandra, Wolff Jennifer L
Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, 12631 E. 17Th Ave B-179, Aurora, CO, 80045, USA.
Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
J Gen Intern Med. 2024 Dec;39(16):3155-3163. doi: 10.1007/s11606-024-09056-3. Epub 2024 Oct 1.
Patients, families, and clinicians increasingly communicate through patient portals. Due to potential for multiple authors, clinicians need to know who is communicating with them. OurNotes is a portal-based pre-visit agenda setting questionnaire. This study adapted OurNotes to include a self-identification question to help clinicians interpret information authored by nonpatients.
To describe adapted OurNotes use and clinician feedback to inform broader implementation.
Evaluation of adapted OurNotes in a geriatric practice.
Older adults with a portal account and a clinic visit; eight clinicians were interviewed.
OurNotes adaptation to clarify whether the author is the patient, the patient with help, or a nonpatient.
Cross-sectional chart review of OurNotes completion, patient characteristics, and visit topics by author type. Clinician interviews explored experiences with OurNotes.
Out of 503 visits, 134 (26%) OurNotes questionnaires were completed. Most respondents (n = 92; 69%) identified as the patient, 18 (14%) identified as the patient with help, and 24 (17%) identified as someone other than the patient. On average, patients who authored their own OurNotes were younger (80.9 years) compared to patients who received assistance (85.8 years), or patients for whom someone else authored OurNotes (87.8 years) (p < 0.001). A diagnosis of cognitive impairment was present among 20% of patients who self-authored OurNotes vs. 79% of patients where someone else authored OurNotes (p < 0.001). Topics differed when OurNotes was authored by patients vs. nonpatients. Symptoms (52% patient vs. 83% nonpatient, p = 0.004), community resources (6% vs. 42%, p < 0.001), dementia (5% vs. 21%, p = 0.009), and care partner concerns (1% vs. 12%, p = 0.002) were more often mentioned by nonpatients. Clinicians valued the self-identification question for increasing transparency about who provided information.
A self-identification question can identify nonpatient authors of OurNotes. Future steps include evaluating whether transparency improves care quality, especially when care partners are involved.
患者、家属和临床医生越来越多地通过患者门户网站进行沟通。由于可能存在多位作者，临床医生需要知道与他们沟通的是谁。OurNotes是一个基于门户网站的就诊前议程设置问卷。本研究对OurNotes进行了调整，增加了一个自我识别问题，以帮助临床医生解读非患者撰写的信息。
描述调整后的OurNotes的使用情况和临床医生的反馈，为更广泛的实施提供参考。
在老年医学实践中对调整后的OurNotes进行评估。
拥有门户网站账户并前来就诊的老年人；采访了8名临床医生。
对OurNotes进行调整，以明确作者是患者、寻求帮助的患者还是非患者。
对OurNotes的完成情况、患者特征和按作者类型划分的就诊主题进行横断面图表审查。临床医生访谈探讨了使用OurNotes的经验。
在503次就诊中，134份（26%）OurNotes问卷被完成。大多数受访者（n = 92；69%）表明自己是患者，18人（14%）表明是寻求帮助的患者，24人（17%）表明是患者以外的其他人。平均而言，自己填写OurNotes的患者（80.9岁）比接受协助的患者（85.8岁）或由他人填写OurNotes的患者（87.8岁）更年轻（p < 0.001）。自我填写OurNotes的患者中20%被诊断为认知障碍，而他人填写OurNotes的患者中这一比例为79%（p < 0.001）。患者和非患者填写OurNotes时涉及的主题有所不同。非患者更常提及症状（患者提及率为52%，非患者为83%，p = 0.004）、社区资源（6%对42%，p < 0.001）、痴呆症（5%对21%，p = 0.009）和护理伙伴关心的问题（1%对12%，p = 0.002）。临床医生重视自我识别问题，认为它提高了信息提供者的透明度。
自我识别问题可以识别OurNotes的非患者作者。未来的步骤包括评估透明度是否能提高护理质量，尤其是在有护理伙伴参与的情况下。
