Fradinho Jorge, Cadman Maria, Burke Ryan C, Blodgett Maxwell, Wolfe Richard, Carr Jayson, Grossman Shamai
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Am J Emerg Med. 2025 Aug;94:3-9. doi: 10.1016/j.ajem.2025.04.020. Epub 2025 Apr 9.
Utilization of different Electronic Health Records (EHR) impedes communication between Emergency Medicine (EM) and Primary Care Provider (PCP) necessitating study on EM's effectiveness in enabling continuity of care following patient discharge. This study's objective was to evaluate the effectiveness of an EM-based follow-up program using secure email for closed-loop communication and follow-up of incidental findings (IF) after EM discharge.
Retrospective study of IFs from two Emergency Departments (ED) and one urgent care between 9/1/20-8/30/21. Preceding day IFs were identified by an EM Quality Assurance (QA) team who then notified the patient's PCP via email. Automated rules-based natural language processing (NLP) of emails linking data to EHRs. Chart reviewing of outcomes included whether closed loop communication was established (via a PCP reply acknowledging IF receipt) and whether follow-up care occurred within 12 months. Multivariate logistic regression models examined factors associated with each outcome.
Of 1781 IF notifications, 62 % were female, 77 % white, and 91 % English speaking. PCP replied to 39.1 %; 64.9 % were ultimately followed-up. Patient and IF characteristics were not associated with PCP reply. PCP tenure and EM/PCP EHR system concordance were associated with higher adjusted Odds Ratio (aOR) of PCP reply (aOR 1.05 [1.04-1.07] vs 2.6 [2.0-3.3]). Laboratory IFs were followed-up more than imaging IFs (aOR 1.94 [1.46-2.6]). EM/PCP Use of same EHR was associated with higher odds of some form of follow-up (aOR: 2.1 [1.7-2.7]).
While email notifications and using the same EHR improve continuity of care, they are insufficient on their own. More comprehensive solutions are needed to enable EM-PCP communication and patient follow-up.
不同电子健康记录（EHR）的使用阻碍了急诊医学（EM）与初级保健提供者（PCP）之间的沟通，因此有必要研究EM在患者出院后实现连续护理方面的有效性。本研究的目的是评估基于EM的随访计划的有效性，该计划使用安全电子邮件进行闭环通信以及对EM出院后的偶然发现（IF）进行随访。
对2020年9月1日至2021年8月30日期间来自两个急诊科（ED）和一个紧急护理机构的IF进行回顾性研究。前一天的IF由EM质量保证（QA）团队确定，然后通过电子邮件通知患者的PCP。通过基于规则的自动化自然语言处理（NLP）将电子邮件中的数据链接到EHR。对结果的图表审查包括是否建立了闭环通信（通过PCP回复确认收到IF）以及后续护理是否在12个月内进行。多变量逻辑回归模型检查与每个结果相关的因素。
在1781条IF通知中，62%为女性，77%为白人，91%说英语。PCP回复率为39.1%；最终64.9%得到了随访。患者和IF特征与PCP回复无关。PCP任期以及EM/PCP EHR系统的一致性与PCP回复的调整后优势比（aOR）较高相关（aOR分别为1.05 [1.04 - 1.07] 和2.6 [2.0 - 3.3]）。实验室IF比影像学IF得到更多随访（aOR为1.94 [1.46 - 2.6]）。EM/PCP使用相同的EHR与某种形式的随访几率较高相关（aOR：2.1 [1.7 - 2.7]）。
虽然电子邮件通知和使用相同的EHR可改善连续护理，但仅靠它们是不够的。需要更全面的解决方案来实现EM - PCP通信和患者随访。
