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Mohd Nawawi MH, Ibrahim MI. Nurses' perceptions of patient handoffs and predictors of patient handoff perceptions in tertiary care hospitals in Kelantan, Malaysia: a cross-sectional study. BMJ Open 2024; 14:e087612. [PMID: 39107013 PMCID: PMC11308887 DOI: 10.1136/bmjopen-2024-087612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/23/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES To study nurses' perceptions of patient handoffs in tertiary care hospitals in Kelantan, Malaysia, and to identify predictors of these perceptions. DESIGN Cross-sectional study. SETTING Three tertiary care hospitals in Kelantan, Malaysia, February-March 2023. PARTICIPANTS The study's inclusion criteria were nurses who were Malaysian citizens, working in shifts and possessing a minimum of 6 months of work experience. Nurses holding administrative positions and those unavailable during the study period were excluded from participation. A stratified proportionate random sampling method was employed, and a 100% response rate was achieved, with all 418 selected nurses participating in the study. OUTCOME MEASURES Nurses' perceptions of patient handoffs were assessed using the validated Hospital Patient Handoff Questionnaire. Predictors of these perceptions were identified through multiple linear regression analysis. RESULTS The study revealed an overall positive perception of handoffs, with a mean score of 3.5 on a 1-5 scale. Receiving formal in-service training on handoff practices (regression coefficient 0.089, 95% CI: 0.016 to 0.161) and expressing satisfaction with the handoff process (regression coefficient 0.330, 95% CI: 0.234 to 0.425) were positively associated with nurses' perceptions. Working in the paediatric department was associated with a lower perception of handoffs (regression coefficient -0.124, 95% CI: -0.195 to -0.053). CONCLUSIONS Formal in-service training, satisfaction and working in the paediatric department were significantly associated with nurses' perceptions of patient handoffs in Kelantan. These findings suggest the need for tailored interventions to improve handoff processes and enhance patient safety. Further research could explore the effectiveness of specific training programmes targeting these identified predictors.
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Affiliation(s)
- Mohd Hanif Mohd Nawawi
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, 16150, Kelantan, Malaysia
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Brlek P, Bulić L, Bračić M, Projić P, Škaro V, Shah N, Shah P, Primorac D. Implementing Whole Genome Sequencing (WGS) in Clinical Practice: Advantages, Challenges, and Future Perspectives. Cells 2024; 13:504. [PMID: 38534348 DOI: 10.3390/cells13060504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
The integration of whole genome sequencing (WGS) into all aspects of modern medicine represents the next step in the evolution of healthcare. Using this technology, scientists and physicians can observe the entire human genome comprehensively, generating a plethora of new sequencing data. Modern computational analysis entails advanced algorithms for variant detection, as well as complex models for classification. Data science and machine learning play a crucial role in the processing and interpretation of results, using enormous databases and statistics to discover new and support current genotype-phenotype correlations. In clinical practice, this technology has greatly enabled the development of personalized medicine, approaching each patient individually and in accordance with their genetic and biochemical profile. The most propulsive areas include rare disease genomics, oncogenomics, pharmacogenomics, neonatal screening, and infectious disease genomics. Another crucial application of WGS lies in the field of multi-omics, working towards the complete integration of human biomolecular data. Further technological development of sequencing technologies has led to the birth of third and fourth-generation sequencing, which include long-read sequencing, single-cell genomics, and nanopore sequencing. These technologies, alongside their continued implementation into medical research and practice, show great promise for the future of the field of medicine.
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Affiliation(s)
- Petar Brlek
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia
- International Center for Applied Biological Research, 10000 Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Luka Bulić
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia
| | - Matea Bračić
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia
| | - Petar Projić
- International Center for Applied Biological Research, 10000 Zagreb, Croatia
| | | | - Nidhi Shah
- Dartmouth Hitchcock Medical Center, Lebannon, NH 03766, USA
| | - Parth Shah
- Dartmouth Hitchcock Medical Center, Lebannon, NH 03766, USA
| | - Dragan Primorac
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia
- International Center for Applied Biological Research, 10000 Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Medical School, University of Split, 21000 Split, Croatia
- Eberly College of Science, The Pennsylvania State University, State College, PA 16802, USA
- The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT 06516, USA
- REGIOMED Kliniken, 96450 Coburg, Germany
- Medical School, University of Rijeka, 51000 Rijeka, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Medical School, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
- National Forensic Sciences University, Gujarat 382007, India
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3
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Kosteniuk J, Morgan D, Elliot V, Bayly M, Froehlich Chow A, Boden C, O'Connell ME. Factors identified as barriers or facilitators to EMR/EHR based interprofessional primary care: a scoping review. J Interprof Care 2024; 38:319-330. [PMID: 37161449 DOI: 10.1080/13561820.2023.2204890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
As interprofessional collaboration (IPC) in primary care receives increasing attention, the role of electronic medical and health record (EMR/EHR) systems in supporting IPC is important to consider. A scoping review was conducted to synthesize the current literature on the barriers and facilitators of EMR/EHRs to interprofessional primary care. Four online databases (OVID Medline, EBSCO CINAHL, OVID EMBASE, and OVID PsycINFO) were searched without date restrictions. Twelve studies were included in the review. Of six facilitator and barrier themes identified, the key facilitator was teamwork support and a significant barrier was data management. Other important barriers included usability related mainly to interoperability, and practice support primarily in terms of patient care. Additional themes were organization attributes and user features. Although EMR/EHR systems facilitated teamwork support, there is potential for team features to be strengthened further. Persistent barriers may be partly addressed by advances in software design, particularly if interprofessional perspectives are included. Organizations and teams might also consider strategies for working with existing EMR/EHR systems, for instance by developing guidelines for interprofessional use. Further research concerning the use of electronic records in interprofessional contexts is needed to support IPC in primary care.
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Affiliation(s)
- Julie Kosteniuk
- Canadian Centre for Health & Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Debra Morgan
- Canadian Centre for Health & Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Valerie Elliot
- Canadian Centre for Health & Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Melanie Bayly
- Canadian Centre for Health & Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Catherine Boden
- Leslie and Irene Dubé Health Sciences Library, University of Saskatchewan, Saskatoon, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
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Meyers D, Miller T, De La Mare J, Gerteis JS, Makulowich G, Weber GH, Zhan C, Genevro J. What AHRQ Learned While Working to Transform Primary Care. Ann Fam Med 2024; 22:161-166. [PMID: 38527822 PMCID: PMC11237207 DOI: 10.1370/afm.3090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 03/27/2024] Open
Abstract
Building on previous efforts to transform primary care, the Agency for Healthcare Research and Quality (AHRQ) launched EvidenceNOW: Advancing Heart Health in 2015. This 3-year initiative provided external quality improvement support to small and medium-size primary care practices to implement evidence-based cardiovascular care. Despite challenges, results from an independent national evaluation demonstrated that the EvidenceNOW model successfully boosted the capacity of primary care practices to improve quality of care, while helping to advance heart health. Reflecting on AHRQ's own learnings as the funder of this work, 3 key lessons emerged: (1) there will always be surprises that will require flexibility and real-time adaptation; (2) primary care transformation is about more than technology; and (3) it takes time and experience to improve care delivery and health outcomes. EvidenceNOW taught us that lasting practice transformation efforts need to be responsive to anticipated and unanticipated changes, relationship-oriented, and not tied to a specific disease or initiative. We believe these lessons argue for a national primary care extension service that provides ongoing support for practice transformation.
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Affiliation(s)
- David Meyers
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Therese Miller
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Jan De La Mare
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Gail Makulowich
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Chunliu Zhan
- Agency for Healthcare Research and Quality, Rockville, Maryland
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Madandola OO, Bjarnadottir RI, Yao Y, Ansell M, Dos Santos F, Cho H, Dunn Lopez K, Macieira TGR, Keenan GM. The relationship between electronic health records user interface features and data quality of patient clinical information: an integrative review. J Am Med Inform Assoc 2023; 31:240-255. [PMID: 37740937 PMCID: PMC10746323 DOI: 10.1093/jamia/ocad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 09/25/2023] Open
Abstract
OBJECTIVES Electronic health records (EHRs) user interfaces (UI) designed for data entry can potentially impact the quality of patient information captured in the EHRs. This review identified and synthesized the literature evidence about the relationship of UI features in EHRs on data quality (DQ). MATERIALS AND METHODS We performed an integrative review of research studies by conducting a structured search in 5 databases completed on October 10, 2022. We applied Whittemore & Knafl's methodology to identify literature, extract, and synthesize information, iteratively. We adapted Kmet et al appraisal tool for the quality assessment of the evidence. The research protocol was registered with PROSPERO (CRD42020203998). RESULTS Eleven studies met the inclusion criteria. The relationship between 1 or more UI features and 1 or more DQ indicators was examined. UI features were classified into 4 categories: 3 types of data capture aids, and other methods of DQ assessment at the UI. The Weiskopf et al measures were used to assess DQ: completeness (n = 10), correctness (n = 10), and currency (n = 3). UI features such as mandatory fields, templates, and contextual autocomplete improved completeness or correctness or both. Measures of currency were scarce. DISCUSSION The paucity of studies on UI features and DQ underscored the limited knowledge in this important area. The UI features examined had both positive and negative effects on DQ. Standardization of data entry and further development of automated algorithmic aids, including adaptive UIs, have great promise for improving DQ. Further research is essential to ensure data captured in our electronic systems are high quality and valid for use in clinical decision-making and other secondary analyses.
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Affiliation(s)
| | | | - Yingwei Yao
- University of Florida College of Nursing, Gainesville, FL, United States
| | - Margaret Ansell
- University of Florida Health Sciences Library, Gainesville, FL, United States
| | - Fabiana Dos Santos
- University of Florida College of Nursing, Gainesville, FL, United States
| | - Hwayoung Cho
- University of Florida College of Nursing, Gainesville, FL, United States
| | - Karen Dunn Lopez
- University of Iowa College of Nursing, Iowa City, IA, United States
| | | | - Gail M Keenan
- University of Florida College of Nursing, Gainesville, FL, United States
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Hendrix N, Bazemore A, Holmgren AJ, Rotenstein LS, Eden AR, Krist AH, Phillips RL. Variation in Family Physicians' Experiences Across Different Electronic Health Record Platforms: a Descriptive Study. J Gen Intern Med 2023; 38:2980-2987. [PMID: 36952084 PMCID: PMC10035476 DOI: 10.1007/s11606-023-08169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Electronic health records (EHRs) have been connected to excessive workload and physician burnout. Little is known about variation in physician experience with different EHRs, however. OBJECTIVE To analyze variation in reported usability and satisfaction across EHRs. DESIGN Internet-based survey available between December 2021 and October 2022 integrated into American Board of Family Medicine (ABFM) certification process. PARTICIPANTS ABFM-certified family physicians who use an EHR with at least 50 total responding physicians. MEASUREMENTS Self-reported experience of EHR usability and satisfaction. KEY RESULTS We analyzed the responses of 3358 physicians who used one of nine EHRs. Epic, athenahealth, and Practice Fusion were rated significantly higher across six measures of usability. Overall, between 10 and 30% reported being very satisfied with their EHR, and another 32 to 40% report being somewhat satisfied. Physicians who use athenahealth or Epic were most likely to be very satisfied, while physicians using Allscripts, Cerner, or Greenway were the least likely to be very satisfied. EHR-specific factors were the greatest overall influence on variation in satisfaction: they explained 48% of variation in the probability of being very satisfied with Epic, 46% with eClinical Works, 14% with athenahealth, and 49% with Cerner. CONCLUSIONS Meaningful differences exist in physician-reported usability and overall satisfaction with EHRs, largely explained by EHR-specific factors. User-centric design and implementation, and robust ongoing evaluation are needed to reduce physician burden and ensure excellent experience with EHRs.
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Affiliation(s)
- Nathaniel Hendrix
- American Board of Family Medicine, Lexington, KY, USA.
- Center for Professionalism and Value in Health Care, Washington, DC, USA.
| | - Andrew Bazemore
- American Board of Family Medicine, Lexington, KY, USA
- Center for Professionalism and Value in Health Care, Washington, DC, USA
| | - A Jay Holmgren
- University of California, San Francisco, San Francisco, CA, USA
| | - Lisa S Rotenstein
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aimee R Eden
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Alex H Krist
- Virginia Commonwealth University, Richmond, VA, USA
| | - Robert L Phillips
- American Board of Family Medicine, Lexington, KY, USA
- Center for Professionalism and Value in Health Care, Washington, DC, USA
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7
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Tsiampalis T, Panagiotakos D. Methodological issues of the electronic health records' use in the context of epidemiological investigations, in light of missing data: a review of the recent literature. BMC Med Res Methodol 2023; 23:180. [PMID: 37559072 PMCID: PMC10410989 DOI: 10.1186/s12874-023-02004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are widely accepted to enhance the health care quality, patient monitoring, and early prevention of various diseases, even when there is incomplete or missing information in them. AIM The present review sought to investigate the impact of EHR implementation on healthcare quality and medical decision in the context of epidemiological investigations, considering missing or incomplete data. METHODS Google scholar, Medline (via PubMed) and Scopus databases were searched for studies investigating the impact of EHR implementation on healthcare quality and medical decision, as well as for studies investigating the way of dealing with missing data, and their impact on medical decision and the development process of prediction models. Electronic searches were carried out up to 2022. RESULTS EHRs were shown that they constitute an increasingly important tool for both physicians, decision makers and patients, which can improve national healthcare systems both for the convenience of patients and doctors, while they improve the quality of health care as well as they can also be used in order to save money. As far as the missing data handling techniques is concerned, several investigators have already tried to propose the best possible methodology, yet there is no wide consensus and acceptance in the scientific community, while there are also crucial gaps which should be addressed. CONCLUSIONS Through the present thorough investigation, the importance of the EHRs' implementation in clinical practice was established, while at the same time the gap of knowledge regarding the missing data handling techniques was also pointed out.
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Affiliation(s)
- Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.
- Faculty of Health, University of Canberra, Canberra, Australia.
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8
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Moloi H, Daniels K, Brooke-Sumner C, Cooper S, Odendaal WA, Thorne M, Akama E, Leon N. Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence. Cochrane Database Syst Rev 2023; 7:CD013603. [PMID: 37466272 PMCID: PMC10355136 DOI: 10.1002/14651858.cd013603.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource settings. However, for a range of reasons, implementation and impact remain variable. PHC integration, at its simplest, can be considered a way of delivering PHC services together that sometimes have been delivered as a series of separate or 'vertical' health programmes. Healthcare workers are known to shape the success of implementing reform interventions. Understanding healthcare worker perceptions and experiences of PHC integration can therefore provide insights into the role healthcare workers play in shaping implementation efforts and the impact of PHC integration. However, the heterogeneity of the evidence base complicates our understanding of their role in shaping the implementation, delivery, and impact of PHC integration, and the role of contextual factors influencing their responses. OBJECTIVES To map the qualitative literature on healthcare workers' perceptions and experiences of PHC integration to characterise the evidence base, with a view to better inform future syntheses on the topic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 28 July 2020. We did not search for grey literature due to the many published records identified. SELECTION CRITERIA We included studies with qualitative and mixed methods designs that reported on healthcare worker perceptions and experiences of PHC integration from any country. We excluded settings other than PHC and community-based health care, participants other than healthcare workers, and interventions broader than healthcare services. We used translation support from colleagues and Google Translate software to screen non-English records. Where translation was not feasible we categorised these records as studies awaiting classification. DATA COLLECTION AND ANALYSIS For data extraction, we used a customised data extraction form containing items developed using inductive and deductive approaches. We performed independent extraction in duplicate for a sample on 10% of studies allowed for sufficient agreement to be reached between review authors. We analysed extracted data quantitatively by counting the number of studies per indicator and converting these into proportions with additional qualitative descriptive information. Indicators included descriptions of study methods, country setting, intervention type, scope and strategies, implementing healthcare workers, and client target population. MAIN RESULTS The review included 184 studies for analysis based on 191 included papers. Most studies were published in the last 12 years, with a sharp increase in the last five years. Studies mostly employed methods with cross-sectional qualitative design (mainly interviews and focus group discussions), and few used longitudinal or ethnographic (or both) designs. Studies covered 37 countries, with close to an even split in the proportions of high-income countries (HICs) and low- and middle-income countries (LMICs). There were gaps in the geographical spread for both HICs and LMICs and some countries were more dominant, such as the USA for HICs, South Africa for middle-income countries, and Uganda for low-income countries. Methods were mainly cross-sectional observational studies with few longitudinal studies. A minority of studies used an analytical conceptual model to guide the design, implementation, and evaluation of the integration study. The main finding was the various levels of diversity found in the evidence base on PHC integration studies that examined healthcare workers' perceptions and experiences. The review identified six different configurations of health service streams that were being integrated and these were categorised as: mental and behavioural health; HIV, tuberculosis (TB) and sexual reproductive health; maternal, women, and child health; non-communicable diseases; and two broader categories, namely general PHC services, and allied and specialised services. Within the health streams, the review mapped the scope of the interventions as full or partial integration. The review mapped the use of three different integration strategies and categorised these as horizontal integration, service expansion, and service linkage strategies. The wide range of healthcare workers who participated in the implementation of integration interventions was mapped and these included policymakers, senior managers, middle and frontline managers, clinicians, allied healthcare professionals, lay healthcare workers, and health system support staff. We mapped the range of client target populations. AUTHORS' CONCLUSIONS This scoping review provides a systematic, descriptive overview of the heterogeneity in qualitative literature on healthcare workers' perceptions and experience of PHC integration, pointing to diversity with regard to country settings; study types; client populations; healthcare worker populations; and intervention focus, scope, and strategies. It would be important for researchers and decision-makers to understand how the diversity in PHC integration intervention design, implementation, and context may influence how healthcare workers shape PHC integration impact. The classification of studies on the various dimensions (e.g. integration focus, scope, strategy, and type of healthcare workers and client populations) can help researchers to navigate the way the literature varies and for specifying potential questions for future qualitative evidence syntheses.
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Affiliation(s)
- Hlengiwe Moloi
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Carrie Brooke-Sumner
- Alcohol Tobacco and Other Drug Research Unit, The South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Social & Behavioural Sciences Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Willem A Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | | | - Eliud Akama
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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Moloi H, Daniels K, Brooke-Sumner C, Cooper S, Odendaal WA, Thorne M, Akama E, Leon N. Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence. Cochrane Database Syst Rev 2023; 7:CD013603. [PMID: 37434293 PMCID: PMC10335778 DOI: 10.1002/14651858.cd013603.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource settings. However, for a range of reasons, implementation and impact remain variable. PHC integration, at its simplest, can be considered a way of delivering PHC services together that sometimes have been delivered as a series of separate or 'vertical' health programmes. Healthcare workers are known to shape the success of implementing reform interventions. Understanding healthcare worker perceptions and experiences of PHC integration can therefore provide insights into the role healthcare workers play in shaping implementation efforts and the impact of PHC integration. However, the heterogeneity of the evidence base complicates our understanding of their role in shaping the implementation, delivery, and impact of PHC integration, and the role of contextual factors influencing their responses. OBJECTIVES To map the qualitative literature on healthcare workers' perceptions and experiences of PHC integration to characterise the evidence base, with a view to better inform future syntheses on the topic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 28 July 2020. We did not search for grey literature due to the many published records identified. SELECTION CRITERIA We included studies with qualitative and mixed methods designs that reported on healthcare worker perceptions and experiences of PHC integration from any country. We excluded settings other than PHC and community-based health care, participants other than healthcare workers, and interventions broader than healthcare services. We used translation support from colleagues and Google Translate software to screen non-English records. Where translation was not feasible we categorised these records as studies awaiting classification. DATA COLLECTION AND ANALYSIS For data extraction, we used a customised data extraction form containing items developed using inductive and deductive approaches. We performed independent extraction in duplicate for a sample on 10% of studies allowed for sufficient agreement to be reached between review authors. We analysed extracted data quantitatively by counting the number of studies per indicator and converting these into proportions with additional qualitative descriptive information. Indicators included descriptions of study methods, country setting, intervention type, scope and strategies, implementing healthcare workers, and client target population. MAIN RESULTS The review included 184 studies for analysis based on 191 included papers. Most studies were published in the last 12 years, with a sharp increase in the last five years. Studies mostly employed methods with cross-sectional qualitative design (mainly interviews and focus group discussions), and few used longitudinal or ethnographic (or both) designs. Studies covered 37 countries, with close to an even split in the proportions of high-income countries (HICs) and low- and middle-income countries (LMICs). There were gaps in the geographical spread for both HICs and LMICs and some countries were more dominant, such as the USA for HICs, South Africa for middle-income countries, and Uganda for low-income countries. Methods were mainly cross-sectional observational studies with few longitudinal studies. A minority of studies used an analytical conceptual model to guide the design, implementation, and evaluation of the integration study. The main finding was the various levels of diversity found in the evidence base on PHC integration studies that examined healthcare workers' perceptions and experiences. The review identified six different configurations of health service streams that were being integrated and these were categorised as: mental and behavioural health; HIV, tuberculosis (TB) and sexual reproductive health; maternal, women, and child health; non-communicable diseases; and two broader categories, namely general PHC services, and allied and specialised services. Within the health streams, the review mapped the scope of the interventions as full or partial integration. The review mapped the use of three different integration strategies and categorised these as horizontal integration, service expansion, and service linkage strategies. The wide range of healthcare workers who participated in the implementation of integration interventions was mapped and these included policymakers, senior managers, middle and frontline managers, clinicians, allied healthcare professionals, lay healthcare workers, and health system support staff. We mapped the range of client target populations. AUTHORS' CONCLUSIONS This scoping review provides a systematic, descriptive overview of the heterogeneity in qualitative literature on healthcare workers' perceptions and experience of PHC integration, pointing to diversity with regard to country settings; study types; client populations; healthcare worker populations; and intervention focus, scope, and strategies. It would be important for researchers and decision-makers to understand how the diversity in PHC integration intervention design, implementation, and context may influence how healthcare workers shape PHC integration impact. The classification of studies on the various dimensions (e.g. integration focus, scope, strategy, and type of healthcare workers and client populations) can help researchers to navigate the way the literature varies and for specifying potential questions for future qualitative evidence syntheses.
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Affiliation(s)
- Hlengiwe Moloi
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Carrie Brooke-Sumner
- Alcohol Tobacco and Other Drug Research Unit, The South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Social & Behavioural Sciences Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Willem A Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | | | - Eliud Akama
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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10
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Zong N, Chowdhury S, Zhou S, Rajaganapathy S, yu Y, Wang L, Dai Q, Bielinski SJ, Chen Y, Cerhan JR. Artificial Intelligence-based Efficacy Prediction of Phase 3 Clinical Trial for Repurposing Heart Failure Therapies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.25.23290531. [PMID: 37398384 PMCID: PMC10312819 DOI: 10.1101/2023.05.25.23290531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Introduction Drug repurposing involves finding new therapeutic uses for already approved drugs, which can save costs as their pharmacokinetics and pharmacodynamics are already known. Predicting efficacy based on clinical endpoints is valuable for designing phase 3 trials and making Go/No-Go decisions, given the potential for confounding effects in phase 2. Objectives This study aims to predict the efficacy of the repurposed Heart Failure (HF) drugs for the Phase 3 Clinical Trial. Methods Our study presents a comprehensive framework for predicting drug efficacy in phase 3 trials, which combines drug-target prediction using biomedical knowledgebases with statistical analysis of real-world data. We developed a novel drug-target prediction model that uses low-dimensional representations of drug chemical structures and gene sequences, and biomedical knowledgebase. Furthermore, we conducted statistical analyses of electronic health records to assess the effectiveness of repurposed drugs in relation to clinical measurements (e.g., NT-proBNP). Results We identified 24 repurposed drugs (9 with a positive effect and 15 with a non-positive) for heart failure from 266 phase 3 clinical trials. We used 25 genes related to heart failure for drug-target prediction, as well as electronic health records (EHR) from the Mayo Clinic for screening, which contained over 58,000 heart failure patients treated with various drugs and categorized by heart failure subtypes. Our proposed drug-target predictive model performed exceptionally well in all seven tests in the BETA benchmark compared to the six cutting-edge baseline methods (i.e., best performed in 266 out of 404 tasks). For the overall prediction of the 24 drugs, our model achieved an AUCROC of 82.59% and PRAUC (average precision) of 73.39%. Conclusion The study demonstrated exceptional results in predicting the efficacy of repurposed drugs for phase 3 clinical trials, highlighting the potential of this method to facilitate computational drug repurposing.
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Affiliation(s)
- Nansu Zong
- Department of Artificial Intelligence and Informatics Research, Mayo Clinic, Rochester, MN, USA
| | - Shaika Chowdhury
- Department of Artificial Intelligence and Informatics Research, Mayo Clinic, Rochester, MN, USA
| | - Shibo Zhou
- Department of Artificial Intelligence and Informatics Research, Mayo Clinic, Rochester, MN, USA
| | - Sivaraman Rajaganapathy
- Department of Artificial Intelligence and Informatics Research, Mayo Clinic, Rochester, MN, USA
| | - Yue yu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Qiying Dai
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Yongbin Chen
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - James R. Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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11
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Petrik AF, Coury J, Larson JH, Badicke B, Coronado GD, Davis MM. Data Challenges in Identifying Patients Due for Colorectal Cancer Screening in Rural Clinics. J Am Board Fam Med 2023; 36:118-129. [PMID: 36759133 PMCID: PMC10187985 DOI: 10.3122/jabfm.2022.220216r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents despite the availability of effective screening methods. Outreach activities can improve CRC screening rates but rely on accurate identification of patients due for screening. We report on data challenges in rural clinics and Medicaid health plans in Oregon in identifying patients eligible for CRC screening, in a large project implementing mailed fecal immunochemical tests (FIT) and patient navigation. METHODS We analyzed data from clinic intake surveys and administrative claims. Clinics were asked to identify total population numbers relevant to CRC screening and follow-up. Health plans also identified enrollees eligible for CRC screening in Spring, 2021. Clinic staff validated patient lists for eligibility using their electronic health records (EHR). RESULTS EHR features varied across the 29 participating and 28 responding clinics. Among the 28 responding clinics, 21 were able to report their Medicaid population (75%), 19 reported the number of patients aged 50 to 75 (68%) and the number screened for CRC in the last year (68%). Only 8 (29%) were able to report screening details such as number screened by FIT and 9 were able to report on patients with an abnormal FIT or colonoscopy completed after FIT (32%). Health plans had challenges properly identifying where enrollees received care and had missing data for race and ethnicity (range 22 to 34% unknown race, <1% to 24% unknown ethnicity). DISCUSSION Most participating rural primary care clinics and Medicaid health plans experienced challenges identifying the population due for a CRC screening outreach program. Better EHR functionality and data reporting capabilities could help rural clinics apply population-based strategies and ultimately attenuate disparities in cancer screening and follow-up.
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Affiliation(s)
- Amanda F Petrik
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD).
| | - Jennifer Coury
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
| | - Jean Hiebert Larson
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
| | - Brittany Badicke
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
| | - Gloria D Coronado
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
| | - Melinda M Davis
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
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12
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Rotenstein LS, Edwards ST, Landon BE. Adult Primary Care Physician Visits Increasingly Address Mental Health Concerns. Health Aff (Millwood) 2023; 42:163-171. [PMID: 36745830 DOI: 10.1377/hlthaff.2022.00705] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A high prevalence of mental health diagnoses in adults alongside ongoing shortages of mental health specialists and expansion of the patient-centered medical home have increased the involvement of primary care clinicians in treating mental health concerns. Using nationally representative serial cross-sectional data from the 2006-18 National Ambulatory Medical Care Surveys regarding visits to outpatient primary care physicians by patients ages eighteen and older, we sought to characterize temporal trends in primary care visits addressing a mental health concern. Based on a sample of 109,898 visits representing 3,891,233,060 weighted visits, we found that the proportion of visits that addressed mental health concerns increased from 10.7 percent of visits in 2006-07 to 15.9 percent by 2016 and 2018. Black patients were 40 percent less likely than White patients to have a mental health concern addressed during a primary care visit, and Hispanic patients were 40 percent less likely than non-Hispanic patients to have a mental health concern addressed during a primary care visit. These findings emphasize the need for payment and billing approaches (that is, value-based care models and billing codes for integrated behavioral health) as well as organizational designs and supports (that is, colocated therapy or psychiatry providers, availability of e-consultation, and longer visits) that enable primary care physicians to adequately address mental health needs.
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Affiliation(s)
- Lisa S Rotenstein
- Lisa S. Rotenstein , Brigham and Women's Hospital, Boston, Massachusetts
| | - Samuel T Edwards
- Samuel T. Edwards, Oregon Health & Science University and Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Bruce E Landon
- Bruce E. Landon, Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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13
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Privacy in electronic health records: a systematic mapping study. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-022-01795-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Abstract
Main
Electronic health record (EHR) applications are digital versions of paper-based patient health information. Traditionally, medical records are made on paper. However, nowadays, advances in information and communication technology have made it possible to change medical records from paper to EHR. Therefore, preserving user data privacy is extremely important in healthcare environments. The main challenges are providing ways to make EHR systems increasingly capable of ensuring data privacy and at the same time not compromising the performance and interoperability of these systems.
Subject and methods
This systematic mapping study intends to investigate the current research on security and privacy requirements in EHR systems and identify potential research gaps in the literature. The main challenges are providing ways to make EHR systems increasingly capable of ensuring data privacy, and at the same time, not compromising the performance and interoperability of these systems. Our research was carried out in the Scopus database, the largest database of abstracts and citations in the literature with peer review.
Results
We have collected 848 articles related to the area. After disambiguation and filtering, we selected 30 articles for analysis. The result of such an analysis provides a comprehensive view of current research.
Conclusions
We can highlight some relevant research possibilities. First, we noticed a growing interest in privacy in EHR research in the last 6 years. Second, blockchain has been used in many EHR systems as a solution to achieve data privacy. However, it is a challenge to maintain traceability by recording metadata that can be mapped to private data of the users applying a particular mapping function that can be hosted outside the blockchain. Finally, the lack of a systematic approach between EHR solutions and existing laws or policies leads to better strategies for developing a certification process for EHR systems.
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14
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Brodar KE, Hong N, Liddle M, Hernandez L, Waks J, Sanchez J, Delamater A, Davis E. Transitioning to Telehealth Services in a Pediatric Diabetes Clinic During COVID-19: An Interdisciplinary Quality Improvement Initiative. J Clin Psychol Med Settings 2022; 29:727-738. [PMID: 34708318 PMCID: PMC8549810 DOI: 10.1007/s10880-021-09830-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 12/17/2022]
Abstract
COVID-19 necessitated a rapid shift to telehealth for psychologists offering consultation-liaison services in pediatric medical settings. However, little is known about how psychologists providing these services adapted to using telehealth service delivery formats. This report details how our interdisciplinary team identified declining psychosocial screener completion and psychology consultation rates as primary challenges following a shift to telehealth within a pediatric diabetes clinic. We utilized the Plan-Do-Study-Act (PDSA) quality improvement framework to improve screening and consultation rates, which initially declined during the telehealth transition. Screening and consultation rates dropped initially, but recovered to nearly pre-pandemic levels following three PDSA intervention cycles. During implementation, challenges arose related to the feasibility of patient interactions, interdisciplinary collaboration, patient engagement, and ethical issues. Clinics shifting psychology consultation-liaison services to telehealth should prioritize interdisciplinary communication, elicit perspectives from all clinic professionals, leverage the electronic health record, and develop procedures for warm handoffs and navigating ethical issues.
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Affiliation(s)
- Kaitlyn E Brodar
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, USA.
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Natalie Hong
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Melissa Liddle
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisandra Hernandez
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Judy Waks
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Janine Sanchez
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan Delamater
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eileen Davis
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, USA
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15
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Gutiérrez-Enríquez SO, Guerrero-Zacarías MC, Oros-Ovalle C, Terán-Figueroa Y, Acuña-Aradillas JM. Computer System for the Capture and Preparation of Cytopathological Reports for Cervical Cancer Detection and His Utility in Training for Health Personnel. Eur J Investig Health Psychol Educ 2022; 12:1323-1333. [PMID: 36135230 PMCID: PMC9498205 DOI: 10.3390/ejihpe12090092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
Health information systems and training are tools that support process management. The current study describes the results of the implementation of technological innovation in the process of the capture and preparation of cytopathological reports. The electronic system was structured based on national standards regarding cervical cancer control. PHP was used to design the software and MYSQL was used for the structure of the database. The total number of health personnel assigned to the cytology department participated, along with a pathologist, who made the records of the patients who came for cervical cytology to a university health center in San Luis Potosi, Mexico. The system was evaluated based on the indicators of structure, process, and results. Structure: comply with the official Mexican regulations for the registration of cervical cancer and electronic health information systems. Process: all records were legible and accurate, with varying percentages of completeness in the patient identification sections (46%) and alternate contact data (80%). Result: percentages above 80% were obtained in the satisfaction of the professionals who used the system. The system was effective as it yielded readable and accurate data that made the process of information capture and delivery of cervical screening results more efficient and faster.
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Affiliation(s)
| | | | - Cuauhtémoc Oros-Ovalle
- Department of Pathological Anatomy, Central Hospital “Dr. Ignacio Morones Prieto”, San Luis Potosi 78290, Mexico
| | - Yolanda Terán-Figueroa
- Faculty of Nursing and Nutrition, Autonomous University of San Luis Potosi, San Luis Potosi 78290, Mexico
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16
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Anskär E, Falk M, Sverker A. 'But there are so many referrals which are totally … only generating work and irritation': a qualitative study of physicians' and nurses' experiences of work tasks in primary care in Sweden. Scand J Prim Health Care 2022; 40:350-359. [PMID: 36325757 PMCID: PMC9848232 DOI: 10.1080/02813432.2022.2139447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study explored the perceptions of physicians and nurses in Swedish primary care regarding the legitimacy of their work tasks and the use of their professional competence. DESIGN AND SETTING This qualitative study was based on manifest content analysis. Data were collected with individual semi-structured interviews of physicians and nurses at publicly managed primary care centres in the Region Östergötland, Sweden. To include both large and small primary care centres, we applied strategic sampling. Among 15 primary care centres invited, nine agreed to participate, including four urban, two suburban, and three rural centres. SUBJECTS The study included 11 physicians and 13 nurses from nine primary care centres. MAIN OUTCOME MEASURES AND RESULTS The physicians and nurses perceived several of their work tasks as illegitimate. In addition, they experienced work-related difficulties, due to resource shortages, challenging electronic data systems, work inefficiencies, and that there were insufficient cooperation with, and problems drawing the line between, primary care and hospital care responsibilities. However, most found that their individual expertise was appropriately used, overall. CONCLUSIONS Strained work situations and illegitimate work tasks may inflate discontentment and lead to negative work stress. Nevertheless, the staff felt that competence was used appropriately in the tasks considered legitimate.Key PointsPhysicians and nurses in primary care in Sweden described several work tasks as illegitimate.Physicians and nurses described problems with heavy workloads, resource shortages, electronic data-system challenges, inefficiencies and with cooperation and drawing the line between primary care and hospital care.Overall, physicians and nurses believed their individual expertise was used appropriately.To uphold sustainable working conditions and thoughtful use of staff competence, organisational measures, such as redistributing staff from hospital to primary care were proposed.
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Affiliation(s)
- Eva Anskär
- Department of Health, Medicine and Caring Sciences, Primary Health Care Center Cityhälsan Centrum, Linköping University, Linköping, Sweden
- CONTACT Eva Anskär Department of Health, Medicine and Caring Sciences, Primary Health Care Center Cityhälsan Centrum, Linköping University, Gamla Lasarettsgatan 18, Norrköping, SE 60239, Sweden
| | - Magnus Falk
- Department of Health, Medicine and Caring Sciences, Kärna Primary Health Care Center, Linköping University, Linköping, Sweden
| | - Annette Sverker
- Department of Activity and Health, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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17
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Yoo S, Lim K, Jung SY, Lee K, Lee D, Kim S, Lee HY, Hwang H. Examining the adoption and implementation of behavioral electronic health records by healthcare professionals based on the clinical adoption framework. BMC Med Inform Decis Mak 2022; 22:210. [PMID: 35941636 PMCID: PMC9361668 DOI: 10.1186/s12911-022-01959-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background While various quantitative studies based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and Technology Acceptance Models (TAM) exist in the general medical sectors, just a few have been conducted in the behavioral sector; they have all been qualitative interview-based studies. Objective The purpose of this study is to assess the adoption dimensions of a behavioral electronic health record (EHR) system for behavioral clinical professionals using a modified clinical adoption (CA) research model that incorporates a variety of micro, meso, and macro level factors. Methods A questionnaire survey with quantitative analysis approach was used via purposive sampling method. We modified the existing CA framework to be suitable for evaluating the adoption of an EHR system by behavioral clinical professionals. We designed and verified questionnaires that fit into the dimensions of the CA framework. The survey was performed in five US behavioral hospitals, and the adoption factors were analyzed using a structural equation analysis. Results We derived a total of seven dimensions, omitting those determined to be unsuitable for behavioral clinical specialists to respond to. We polled 409 behavioral clinical experts from five hospitals. As a result, the ease of use and organizational support had a substantial impact on the use of the behavioral EHR system. Although the findings were not statistically significant, information and service quality did appear to have an effect on the system's ease of use. The primary reported benefit of behavioral EHR system adoption was the capacity to swiftly locate information, work efficiently, and access patient information via a mobile app, which resulted in more time for better care. The primary downside, on the other hand, was an unhealthy reliance on the EHR system. Conclusions We demonstrated in this study that the CA framework can be a useful tool for evaluating organizational and social elements in addition to the EHR system's system features. Not only the EHR system's simplicity of use, but also organizational support, should be considered for the effective implementation of the behavioral EHR system. Trial Registration: The study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No.: B-1904-534-301).
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Affiliation(s)
- Sooyoung Yoo
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kahyun Lim
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Young Jung
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keehyuck Lee
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Donghyun Lee
- Department of Education and Training, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seok Kim
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ho-Young Lee
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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18
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Shiner B, Levis M, Dufort VM, Patterson OV, Watts BV, DuVall SL, Russ CJ, Maguen S. Improvements to PTSD quality metrics with natural language processing. J Eval Clin Pract 2022; 28:520-530. [PMID: 34028937 DOI: 10.1111/jep.13587] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 01/07/2023]
Abstract
RATIONALE AIMS AND OBJECTIVES As quality measurement becomes increasingly reliant on the availability of structured electronic medical record (EMR) data, clinicians are asked to perform documentation using tools that facilitate data capture. These tools may not be available, feasible, or acceptable in all clinical scenarios. Alternative methods of assessment, including natural language processing (NLP) of clinical notes, may improve the completeness of quality measurement in real-world practice. Our objective was to measure the quality of care for a set of evidence-based practices using structured EMR data alone, and then supplement those measures with additional data derived from NLP. METHOD As a case example, we studied the quality of care for posttraumatic stress disorder (PTSD) in the United States Department of Veterans Affairs (VA) over a 20-year period. We measured two aspects of PTSD care, including delivery of evidence-based psychotherapy (EBP) and associated use of measurement-based care (MBC), using structured EMR data. We then recalculated these measures using additional data derived from NLP of clinical note text. RESULTS There were 2 098 389 VA patients with a diagnosis of PTSD between 2000 and 2019, 72% (n = 1 515 345) of whom had not previously received EBP for PTSD and were treated after a 2015 mandate to document EBP using templates that generate structured EMR data. Using structured EMR data, we determined that 3.2% (n = 48 004) of those patients met our EBP for PTSD quality standard between 2015 and 2019, and 48.1% (n = 23 088) received associated MBC. With the addition of NLP-derived data, estimates increased to 4.1% (n = 62 789) and 58.0% (n = 36 435), respectively. CONCLUSION Healthcare quality data can be significantly improved by supplementing structured EMR data with NLP-derived data. By using NLP, health systems may be able to fill the gaps in documentation when structured tools are not yet available or there are barriers to using them in clinical practice.
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Affiliation(s)
- Brian Shiner
- Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,National Center for PTSD, White River Junction, Vermont, USA
| | - Maxwell Levis
- Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Vincent M Dufort
- Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Olga V Patterson
- VA Medical Center, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, Utah, USA
| | - Bradley V Watts
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,VA Office of Systems Redesign and Improvement, Washington, District of Columbia, USA
| | - Scott L DuVall
- VA Medical Center, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, Utah, USA
| | - Carey J Russ
- Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Shira Maguen
- VA Medical Center, San Francisco, California, USA.,School of Medicine, University of California San Francisco, San Francisco, California, USA
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19
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Pfoh ER, Hohman JA, Alcorn K, Vakharia N, Rothberg MB. Linking Primary Care Patients to Mental Health Care via Behavioral Health Social Workers: A Stepped-Wedge Study. Psychiatr Serv 2022; 73:864-871. [PMID: 34991343 DOI: 10.1176/appi.ps.202100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Demand for systematic linkage of patients to behavioral health care has increased because of the widespread implementation of depression screening. This study assessed the impact of deploying behavioral health social workers (BHSWs) in primary care on behavioral health visits for depression or anxiety. METHODS This quasi-experimental, stepped-wedge study included adults with a primary care visit between 2016 and 2019 at Cleveland Clinic, a large integrated health system. BHSWs were deployed in 40 practices between 2017 and 2019. Patients were allocated to a control group (diagnosed before BHSW deployment) and an intervention group (diagnosed after deployment). Data were collected on behavioral health visits (i.e., to therapists and psychiatrists) within 30 days of the diagnosis. Multilevel logistic regression models identified associations between BHSW deployment period and behavioral health visit, adjusted for demographic variables and clustering within each group. RESULTS Of 68,659 persons with a diagnosis, 21% had a depression diagnosis, 49% an anxiety diagnosis, and 31% both diagnoses. In the period after BHSW deployment, the proportion of patients with depression who had a behavioral health visit increased by 10 percentage points, of patients with anxiety by 9 percentage points, and of patients with both disorders by 11 percentage points. The adjusted odds of having a behavioral health visit was higher in the postdeployment period for patients with depression (adjusted odds ratio [AOR]=4.35, 95% confidence interval [CI]=3.50-5.41), anxiety (AOR=4.27, 95% CI=3.57-5.11), and both (AOR= 3.26, 95% CI=2.77-3.84). CONCLUSIONS Integration of BHSWs in primary care was associated with increased behavioral health visits.
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Affiliation(s)
- Elizabeth R Pfoh
- Center for Value-Based Care Research (Pfoh, Rothberg), Cleveland Clinic Community Care (Hohman, Vakharia), and Department of Psychology (Alcorn), Cleveland Clinic, Cleveland
| | - Jessica A Hohman
- Center for Value-Based Care Research (Pfoh, Rothberg), Cleveland Clinic Community Care (Hohman, Vakharia), and Department of Psychology (Alcorn), Cleveland Clinic, Cleveland
| | - Kathleen Alcorn
- Center for Value-Based Care Research (Pfoh, Rothberg), Cleveland Clinic Community Care (Hohman, Vakharia), and Department of Psychology (Alcorn), Cleveland Clinic, Cleveland
| | - Nirav Vakharia
- Center for Value-Based Care Research (Pfoh, Rothberg), Cleveland Clinic Community Care (Hohman, Vakharia), and Department of Psychology (Alcorn), Cleveland Clinic, Cleveland
| | - Michael B Rothberg
- Center for Value-Based Care Research (Pfoh, Rothberg), Cleveland Clinic Community Care (Hohman, Vakharia), and Department of Psychology (Alcorn), Cleveland Clinic, Cleveland
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20
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Kariotis TC, Prictor M, Chang S, Gray K. Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review. J Med Internet Res 2022; 24:e30405. [PMID: 35507393 PMCID: PMC9118021 DOI: 10.2196/30405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/14/2021] [Accepted: 01/13/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided. OBJECTIVE This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts. METHODS We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies' results and address the research questions. RESULTS The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health-related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used. CONCLUSIONS We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.
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Affiliation(s)
- Timothy Charles Kariotis
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
- Melbourne School of Government, The University of Melbourne, Carlton, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Carlton, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
| | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
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21
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Moon K, Sobolev M, Kane JM. Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review. JMIR Ment Health 2022; 9:e30810. [PMID: 35171105 PMCID: PMC8892315 DOI: 10.2196/30810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/08/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. OBJECTIVE This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. METHODS This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. RESULTS A total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest. CONCLUSIONS The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials.
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Affiliation(s)
- Khatiya Moon
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Michael Sobolev
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Cornell Tech, Cornell University, New York City, NY, United States
| | - John M Kane
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
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22
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Winckler D. Not another box to check! Using the UTAUT to explore nurses' psychological adaptation to electronic health record usability. Nurs Forum 2021; 57:412-420. [PMID: 34957564 DOI: 10.1111/nuf.12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND As the integration of electronic health records (EHRs) continues to expand throughout healthcare organizations worldwide, nurses are faced with the challenge to acclimate to a dynamic technology-based environment of patient care. As technology advances, EHR usability may influence nurses' clinical performance and require nurses to adapt to a wide range of situations associated with electronic documentation. While perceived benefits of EHRs include improvements in healthcare delivery and patient outcomes, there are also unintended consequences associated with EHR usability. AIMS The aim of this article is to explore dimensions of EHR usability that may influence nurses' psychological adaptation to the use of EHRs in daily practice. MATERIALS AND METHODS The unified theory of acceptance and use of technology (UTAUT) consists of four constructs theorized to have a direct influence on end-user behavior and acceptance of technology: performance expectancy, effort expectancy, social influence, and facilitating conditions. The UTAUT provides the framework to explore EHR usability as found in literature and describe the positive and negative psychological responses of nurses related to the use of EHRs in daily practice. RESULTS Integration of EHRs into daily nursing practice can result in positive experiences or have a negative impact on nurses ability to perform their role as patient caregivers. DISCUSSION While integration of EHRs into healthcare systems can facilitate improvements in patient outcomes, the delivery of patient care and nurses' daily practices can simultaneously be complicated by EHR usability issues. CONCLUSION Although positive and negative experiences of nurses in relationship to EHR usability can be found in literature, there is limited evidence on nurses' psychological adaptation to use of EHRs. Further research on EHR usability is needed based on nursing perspectives and feedback to determine the psychological impact EHRs exert on nurses, discover effective methods for resolving issues, and promote positive trends associated with EHR usability.
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Matthews EB, Akincigil A. The impact of electronic health record functions on patterns of depression treatment in primary care. Inform Health Soc Care 2021; 47:295-304. [PMID: 34672856 DOI: 10.1080/17538157.2021.1990933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Many individuals with depression are not being linked to treatment by their primary care providers. Electronic health records (EHRs) are common in medicine, but their impact on depression treatment is mixed. Because EHRs are diverse, differences may be attributable to differences in functionality. This study examines the relationship between EHR functions, and patterns of depression treatment in primary care. METHODS secondary analyses from the 2013-2016 National Ambulatory Medical Care Survey examined adult primary care patients with new or acute depression (n = 5,368). Bivariate comparisons examined patterns of depression treatment by general EHR use, and logistic regression examined the impact of individual EHR functions on treatment receipt. RESULTS Half the sample (57%; N = 3,034) was linked to depression treatment. Of this, 98.5% (n = 2,985) were prescribed antidepressants, while 4.3% (n = 130) were linked to mental health. EHR use did not impact mental health linkages, but EHR functions did affect antidepressant prescribing. Medication reconciliation decreased the odds of receiving an antidepressant (OR = .60, p < .05), while contraindication warnings increased the likelihood of an antidepressant prescription (OR = 1.91, p < .001). CONCLUSIONS EHR systems did not impact mental health linkages but improved rates of antidepressant prescribing. Optimizing the use of contraindication warnings may be a key mechanism to encourage antidepressant treatment.
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Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University - Lincoln Center Campus, New York, New York, USA
| | - Ayse Akincigil
- School of Social Work, Rutgers the State University of New Jersey, New Brunswick, USA
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24
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Dos Santos Treichel CA, Bakolis I, Onocko-Campos RT. Primary care registration of the mental health needs of patients treated at outpatient specialized services: results from a medium-sized city in Brazil. BMC Health Serv Res 2021; 21:1095. [PMID: 34654434 PMCID: PMC8518259 DOI: 10.1186/s12913-021-07127-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although matrix support seeks to promote integrating Primary Care with specialized mental health services in Brazil, little is known about the quantitative impact of this strategy on sharing cases between different levels of care. The aim of this study was to investigate the prevalence and factors associated with Primary Care registration of the mental health needs of patients treated at outpatient specialized services in a medium-sized city in Brazil with recent implementation of matrix support. METHODS This is a document-based cross-sectional study conducted through an analysis of 1198 patients' medical records. Crude and adjusted associations with the outcome were explored using logistic regression. RESULTS The prevalence of cases registered in Primary Care was 40% (n = 479). Evidence was found for associations between the outcome and the patients being over 30 years old, and referral by emergency or hospital services. There was conversely an inverse association between the outcome and status as a patient from the Outpatient Clinic or from the Psychosocial Care Center for psychoactive substance misuse. CONCLUSIONS Even with the provision of mechanisms for network integration, such as matrix support, our results suggest that more groundwork is necessary to ensure that sharing cases between Primary Care and specialized services is effective.
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Affiliation(s)
- Carlos Alberto Dos Santos Treichel
- Department of Collective Health, School of Medical Sciences, University of Campinas, St. Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-887, Brazil.
| | - Ioannis Bakolis
- Health Services and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosana Teresa Onocko-Campos
- Department of Collective Health, School of Medical Sciences, University of Campinas, St. Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-887, Brazil
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25
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Palojoki S, Saranto K, Reponen E, Skants N, Vakkuri A, Vuokko R. Classification of Electronic Health Record-Related Patient Safety Incidents: Development and Validation Study. JMIR Med Inform 2021; 9:e30470. [PMID: 34245558 PMCID: PMC8441612 DOI: 10.2196/30470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/10/2021] [Accepted: 07/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied. Results The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.
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Affiliation(s)
- Sari Palojoki
- Department of Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, Helsinki, Finland.,Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Kaija Saranto
- Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland
| | - Elina Reponen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Noora Skants
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Anne Vakkuri
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Riikka Vuokko
- Department of Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, Helsinki, Finland
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Abebe E, Scanlon MC, Chen H, Yu D. Complexity of Documentation Needs for Children With Medical Complexity: Implications for Hospital Providers. Hosp Pediatr 2021; 10:670-678. [PMID: 32727931 DOI: 10.1542/hpeds.2020-0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Care coordination is a core component of pediatric complex care programs (CCPs) supporting children with medical complexity (CMC) and their families. In this study, we aim to describe the purpose and characteristics of clinical care notes used within a pediatric CCP. METHODS We conducted observations of provider-family interactions during CCP clinic visits and 5 focus groups with members of the CCP. Focus groups were recorded and transcribed. Field observation notes and focus group transcripts were subjected to qualitative content analyses. RESULTS Four major themes help characterize clinical care notes: (1) Diversity of note types and functions: program staff author and use a number of unique note types shared across multiple stakeholders, including clinicians, families, and payers. (2) motivations for care note generation are different and explain how, why, and where they are created. (3) Program staff roles and configuration vary in relation to care note creation and use. (4) Sources of information for creating and updating notes are also diverse. Given the disparate information sources, integrating and maintaining up-to-date information for the child is challenging. To minimize information gaps, program staff devised unique but resource-intensive strategies, such as accompanying families during specialty clinic visits or visiting them inpatient. CONCLUSIONS CMC have complex documentation needs demonstrated by a variety of professional roles, care settings, and stakeholders involved in the generation and use of notes. Multiple opportunities exist to redesign and streamline the existing notes to support the cognitive work of clinicians providing care for CMC.
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Affiliation(s)
- Ephrem Abebe
- Department of Pharmacy Practice, College of Pharmacy and
| | - Matthew C Scanlon
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Haozhi Chen
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana; and
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana; and
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27
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Keshta I, Odeh A. Security and privacy of electronic health records: Concerns and challenges. EGYPTIAN INFORMATICS JOURNAL 2021. [DOI: 10.1016/j.eij.2020.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lasser EC, Kim JM, Hatef E, Kharrazi H, Marsteller JA, DeCamp LR. Social and Behavioral Variables in the Electronic Health Record: A Path Forward to Increase Data Quality and Utility. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1050-1056. [PMID: 33735133 PMCID: PMC8243784 DOI: 10.1097/acm.0000000000004071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE Social and behavioral determinants of health (SBDH) are important factors that affect the health of individuals but are not routinely captured in a structured and systematic manner in electronic health records (EHRs). The purpose of this study is to generate recommendations for systematic implementation of SBDH data collection in EHRs through (1) reviewing SBDH conceptual and theoretical frameworks and (2) eliciting stakeholder perspectives on barriers to and facilitators of using SBDH information in the EHR and priorities for data collection. METHOD The authors reviewed SBDH frameworks to identify key social and behavioral variables and conducted focus groups and interviews with 17 clinicians and researchers at Johns Hopkins Health System between March and May 2018. Transcripts were coded and common themes were extracted to understand the barriers to and facilitators of accessing SBDH information. RESULTS The authors found that although the frameworks agreed that SBDH affect health outcomes, the lack of model consensus complicates the development of specific recommendations for the prioritization of SBDH data collection. Study participants recognized the importance of SBDH information and individual health and agreed that patient-reported information should be captured, but clinicians and researchers cited different priorities for which variables are most important. For the few SBDH variables that are captured, participants reported that data were often incomplete, unclear, or inconsistent, affecting both researcher and clinician responses to SBDH barriers to health. CONCLUSIONS Health systems need to identify and prioritize the systematic implementation of collection of a high-impact but limited list of SBDH variables in the EHR. These variables should affect care and be amenable to change and collection should be integrated into clinical workflows. Improved data collection of SBDH variables can lead to a better understanding of how SBDH affect health outcomes and ways to better address underlying health disparities that need urgent action.
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Affiliation(s)
- Elyse C Lasser
- E.C. Lasser is research associate, Johns Hopkins Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ORCID: https://orcid.org/0000-0002-1758-9822
| | - Julia M Kim
- J.M. Kim is assistant professor, Department of Pediatrics, and faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0001-5678-6629
| | - Elham Hatef
- E. Hatef is assistant scientist, Johns Hopkins Center for Population Health Information Technology and Center for Health Disparities Solutions, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-2535-8191
| | - Hadi Kharrazi
- H. Kharrazi is associate professor, Johns Hopkins Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-1481-4323
| | - Jill A Marsteller
- J.A. Marsteller is professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0002-8458-954X
| | - Lisa Ross DeCamp
- L.R. DeCamp is associate professor, ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Denver, Colorado; ORCID: https://orcid.org/0000-0002-5210-4675
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Tauscher JS, Cohn EB, Johnson TR, Diteman KD, Ries RK, Atkins DC, Hallgren KA. What do clinicians want? Understanding frontline addiction treatment clinicians' preferences and priorities to improve the design of measurement-based care technology. Addict Sci Clin Pract 2021; 16:38. [PMID: 34130724 PMCID: PMC8205211 DOI: 10.1186/s13722-021-00247-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/03/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Measurement-based care (MBC) is the practice of routinely administering standardized measures to support clinical decision-making and monitor treatment progress. Despite evidence of its effectiveness, MBC is rarely adopted in routine substance use disorder (SUD) treatment settings and little is known about the factors that may improve its adoptability in these settings. The current study gathered qualitative data from SUD treatment clinicians about their perceptions of MBC, the clinical outcomes they would most like to monitor in MBC, and suggestions for the design and implementation of MBC systems in their settings. METHODS Fifteen clinicians from one publicly-funded and two privately-funded outpatient SUD treatment clinics participated in one-on-one research interviews. Interviews focused on clinicians' perceived benefits, drawbacks, and ideas related to implementing MBC technology into their clinical workflows. Interviews were audio recorded, transcribed, and coded to allow for thematic analysis using a mixed deductive and inductive approach. Clinicians also completed a card sorting task to rate the perceived helpfulness of routinely measuring and monitoring different treatment outcomes. RESULTS Clinicians reported several potential benefits of MBC, including improved patient-provider communication, client empowerment, and improved communication between clinicians. Clinicians also expressed potential drawbacks, including concerns about subjectivity in patient self-reports, limits to personalization, increased time burdens, and needing to learn to use new technologies. Clinicians generated several ideas and preferences aimed at minimizing burden of MBC, illustrating clinical changes over time, improving ease of use, and improving personalization. Numerous patient outcomes were identified as "very helpful" to track, including coping skills, social support, and motivation for change. CONCLUSIONS MBC may be a beneficial tool for improving clinical care in SUD treatment settings. MBC tools may be particularly adoptable if they are compatible with existing workflows, help illustrate gradual and nonlinear progress in SUD treatment, measure outcomes perceived as clinically useful, accommodate multiple use cases and stakeholder groups, and are framed as an additional source of information meant to augment, rather than replace, existing practices and information sources.
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Affiliation(s)
- Justin S Tauscher
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA
| | - Eliza B Cohn
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA
| | - Tascha R Johnson
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA
| | - Kaylie D Diteman
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA
| | - Richard K Ries
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA
| | - David C Atkins
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA
| | - Kevin A Hallgren
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA.
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Improving continuity of HIV/AIDS care through electronic health records in resource-limited settings: A Botswana perspective. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cochran RA, Feldman SS, Ivankova NV, Hall AG, Opoku-Agyeman W. Intention to Use Behavioral Health Data From a Health Information Exchange: Mixed Methods Study. JMIR Ment Health 2021; 8:e26746. [PMID: 34042606 PMCID: PMC8193493 DOI: 10.2196/26746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with co-occurring behavioral health and chronic medical conditions frequently overuse inpatient hospital services. This pattern of overuse contributes to inefficient health care spending. These patients require coordinated care to achieve optimal health outcomes. However, the poor exchange of health-related information between various clinicians renders the delivery of coordinated care challenging. Health information exchanges (HIEs) facilitate health-related information sharing and have been shown to be effective in chronic disease management; however, their effectiveness in the delivery of integrated care is less clear. It is prudent to consider new approaches to sharing both general medical and behavioral health information. OBJECTIVE This study aims to identify and describe factors influencing the intention to use behavioral health information that is shared through HIEs. METHODS We used a mixed methods design consisting of two sequential phases. A validated survey instrument was emailed to clinical and nonclinical staff in Alabama and Oklahoma. The survey captured information about the impact of predictors on the intention to use behavioral health data in clinical decision making. Follow-up interviews were conducted with a subsample of participants to elaborate on the survey results. Partial least squares structural equation modeling was used to analyze survey data. Thematic analysis was used to identify themes from the interviews. RESULTS A total of 62 participants completed the survey. In total, 63% (n=39) of the participants were clinicians. Performance expectancy (β=.382; P=.01) and trust (β=.539; P<.001) predicted intention to use behavioral health information shared via HIEs. The interviewees (n=5) expressed that behavioral health information could be useful in clinical decision making. However, privacy and confidentiality concerns discourage sharing this information, which is generally missing from patient records altogether. The interviewees also stated that training for HIE use was not mandatory; the training that was provided did not focus specifically on the exchange of behavioral health information. CONCLUSIONS Despite barriers, individuals are willing to use behavioral health information from HIEs if they believe that it will enhance job performance and if the information being transmitted is trustworthy. The findings contribute to our understanding of the role HIEs can play in delivering integrated care, particularly to vulnerable patients.
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Affiliation(s)
- Randyl A Cochran
- Department of Health Sciences, College of Health Professions, Towson University, Towson, MD, United States
| | - Sue S Feldman
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nataliya V Ivankova
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Allyson G Hall
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William Opoku-Agyeman
- School of Health and Applied Human Sciences, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, NC, United States
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Rahal RM, Mercer J, Kuziemsky C, Yaya S. Factors affecting the mature use of electronic medical records by primary care physicians: a systematic review. BMC Med Inform Decis Mak 2021; 21:67. [PMID: 33607986 PMCID: PMC7893965 DOI: 10.1186/s12911-021-01434-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite a substantial increase in the adoption of electronic medical records (EMRs) in primary health care settings, the use of advanced EMR features is limited. Several studies have identified both barriers and facilitating factors that influence primary care physicians' (PCPs) use of advanced EMR features and the maturation of their EMR use. The purpose of this study is to explore and identify the factors that impact PCPs' mature use of EMRs. METHODS A systematic review was conducted in accordance with the Cochrane Handbook. The MEDLINE, Embase, and PsycINFO electronic databases were searched from 1946 to June 13, 2019. Two independent reviewers screened the studies for eligibility; to be included, studies had to address factors influencing PCPs' mature use of EMRs. A narrative synthesis was conducted to collate study findings and to report on patterns identified across studies. The quality of the studies was also appraised. RESULTS Of the 1893 studies identified, 14 were included in this study. Reported factors that influenced PCPs' mature use of EMRs fell into one of the following 5 categories: technology, people, organization, resources, and policy. Concerns about the EMR system's functionality, lack of physician awareness of EMR functionality, limited physician availability to learn more about EMRs, the habitual use of successfully completing clinical tasks using only basic EMR features, business-oriented organizational objectives, lack of vendor training, limited resource availability, and lack of physician readiness were reported as barriers to PCPs' mature use of EMRs. The motivation of physicians, user satisfaction, coaching and peer mentoring, EMR experience, gender, physician perception, transition planning for changes in roles and work processes, team-based care, adequate technical support and training, sharing resources, practices affiliated with an integrated delivery system, financial incentives, and policies to increase EMR use all had a favorable impact on PCPs' use of advanced EMR features. CONCLUSIONS By using a narrative synthesis to synthesize the evidence, we identified interrelated factors influencing the mature use of EMRs by PCPs. The findings underline the need to provide adequate training and policies that facilitate the mature use of EMRs by PCPs. TRIAL REGISTRATION PROSPERO CRD42019137526.
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Affiliation(s)
- Rana Melissa Rahal
- Population Health Program, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 7K4, Canada.
| | - Jay Mercer
- Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Craig Kuziemsky
- Office of Research Services, MacEwan University, Edmonton, Alberta, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, University College London, London, UK
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Madhavan S, Bastarache L, Brown JS, Butte AJ, Dorr DA, Embi PJ, Friedman CP, Johnson KB, Moore JH, Kohane IS, Payne PRO, Tenenbaum JD, Weiner MG, Wilcox AB, Ohno-Machado L. Use of electronic health records to support a public health response to the COVID-19 pandemic in the United States: a perspective from 15 academic medical centers. J Am Med Inform Assoc 2021; 28:393-401. [PMID: 33260207 PMCID: PMC7665546 DOI: 10.1093/jamia/ocaa287] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/12/2022] Open
Abstract
Our goal is to summarize the collective experience of 15 organizations in dealing with uncoordinated efforts that result in unnecessary delays in understanding, predicting, preparing for, containing, and mitigating the COVID-19 pandemic in the US. Response efforts involve the collection and analysis of data corresponding to healthcare organizations, public health departments, socioeconomic indicators, as well as additional signals collected directly from individuals and communities. We focused on electronic health record (EHR) data, since EHRs can be leveraged and scaled to improve clinical care, research, and to inform public health decision-making. We outline the current challenges in the data ecosystem and the technology infrastructure that are relevant to COVID-19, as witnessed in our 15 institutions. The infrastructure includes registries and clinical data networks to support population-level analyses. We propose a specific set of strategic next steps to increase interoperability, overall organization, and efficiencies.
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Affiliation(s)
- Subha Madhavan
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey S Brown
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Atul J Butte
- University of California Health System (UC Health), University of California, San Francisco, California, USA
| | - David A Dorr
- Departments of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Peter J Embi
- Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Charles P Friedman
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jason H Moore
- Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip R O Payne
- Institute for Informatics, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Jessica D Tenenbaum
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark G Weiner
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Adam B Wilcox
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla, California, USA
- Division of Health Services Research & Development, VA San Diego Healthcare System, San Diego, California, USA
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Ma Q, Mack M, Shambhu S, McTigue K, Haynes K. Characterization of bariatric surgery and outcomes using administrative claims data in the research network of a nationwide commercial health plan. BMC Health Serv Res 2021; 21:116. [PMID: 33541346 PMCID: PMC7860025 DOI: 10.1186/s12913-021-06074-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background The supplementation of electronic health records data with administrative claims data may be used to capture outcome events more comprehensively in longitudinal observational studies. This study investigated the utility of administrative claims data to identify outcomes across health systems using a comparative effectiveness study of different types of bariatric surgery as a model. Methods This observational cohort study identified patients who had bariatric surgery between 2007 and 2015 within the HealthCore Anthem Research Network (HCARN) database in the National Patient-Centered Clinical Research Network (PCORnet) common data model. Patients whose procedures were performed in a member facility affiliated with PCORnet Clinical Research Networks (CRNs) were selected. The outcomes included a 30-day composite adverse event (including venous thromboembolism, percutaneous/operative intervention, failure to discharge and death), and all-cause hospitalization, abdominal operation or intervention, and in-hospital death up to 5 years after the procedure. Outcomes were classified as occurring within or outside PCORnet CRN health systems using facility identifiers. Results We identified 4899 patients who had bariatric surgery in one of the PCORnet CRN health systems. For 30-day composite adverse event, the inclusion of HCARN multi-site claims data marginally increased the incidence rate based only on HCARN single-site claims data for PCORnet CRNs from 3.9 to 4.2%. During the 5-year follow-up period, 56.8% of all-cause hospitalizations, 31.2% abdominal operations or interventions, and 32.3% of in-hospital deaths occurred outside PCORnet CRNs. Incidence rates (events per 100 patient-years) were significantly lower when based on claims from a single PCORnet CRN only compared to using claims from all health systems in the HCARN: all-cause hospitalization, 11.0 (95% Confidence Internal [CI]: 10.4, 11.6) to 25.3 (95% CI: 24.4, 26.3); abdominal operations or interventions, 4.2 (95% CI: 3.9, 4.6) to 6.1 (95% CI: 5.7, 6.6); in-hospital death, 0.2 (95% CI: 0.11, 0.27) to 0.3 (95% CI: 0.19, 0.38). Conclusions Short-term inclusion of multi-site claims data only marginally increased the incidence rate computed from single-site claims data alone. Longer-term follow up captured a notable number of events outside of PCORnet CRNs. The findings suggest that supplementing claims data improves the outcome ascertainment in longitudinal observational comparative effectiveness studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06074-3.
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Affiliation(s)
- Qinli Ma
- Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, DE, USA.
| | - Michael Mack
- Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, DE, USA
| | - Sonali Shambhu
- Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, DE, USA
| | - Kathleen McTigue
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin Haynes
- Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, DE, USA
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Thompson EL, Fulda KG, Grace J, Galvin AM, Spence EE. The Implementation of an Interpersonal Violence Screening Program in Primary Care Settings: Lessons Learned. Health Promot Pract 2021; 23:640-649. [PMID: 33504222 DOI: 10.1177/1524839921989273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Interpersonal violence (IPV) is a public health issue that disproportionately affects women. IPV screening improves likelihood of survivor disclosure and access to additional support. To enhance primary care IPV screening, Technology Enhanced Screening and Supportive Assistance (TESSA) uses integrated technological systems to deliver bidirectional, evidence-informed health navigation, health management, and safety interventions. This study evaluates TESSA implementation in primary care clinics using the Consolidated Framework for Implementation Research (CFIR). METHOD CFIR is a metatheoretical framework used for evaluating clinical intervention implementation. Salient constructs within CFIR's five domains (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process) were identified (23 constructs), and pertinent implementation details were examined. RESULTS Key lessons learned included intervention characteristic constructs like intervention source (e.g., selecting tablets that can screen for items integral to the program's aims) and adaptability (e.g., ensuring tablets worked with electronic medical records for each clinic), process constructs like engaging champions (e.g., garnering buy-in from key clinic stakeholders and staff), outer setting constructs like patient needs and resources (e.g., addressing pertinent patient resource needs) and external policies and incentives (e.g., incentivizing clinics by addressing clinic needs), and inner setting constructs like leadership engagement (e.g., ensuring buy-in from organizational leaders as leadership changed frequently). CONCLUSIONS CFIR identifies important implementation factors for programs like TESSA that screen for high-risk populations and implement in primary care settings. The TESSA program implementation permits increased IPV screening among primary health care populations, thus promoting access to resources for otherwise hard-to-reach populations.
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Affiliation(s)
- Erika L Thompson
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kimberly G Fulda
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Jessica Grace
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Annalynn M Galvin
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Emily E Spence
- University of North Texas Health Science Center, Fort Worth, TX, USA
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Abstract
Approximately 30-50% of persons living with HIV manifest some degree of neurocognitive impairment. Even mild-to-moderate forms of HIV-associated neurocognitive disorders (HAND) can result in difficulties with everyday functioning, such as suboptimal medication adherence and impaired driving. Despite the pervasive presence and consequences of HAND, there is a significant unmet need to develop effective behavioral strategies to reduce the incidence and consequences of HAND. Although there is an absence of evidence-based behavioral interventions specific to HAND, the literature reviewed in this chapter suggest the following modifiable lifestyle factors as intervention targets: physical activity, diet, sleep, and antiretroviral medication adherence. Adoption and maintenance of these healthy lifestyle factors may reduce inflammation and oxidative stress, which, in turn, may reduce the incidence and/or severity of HAND.
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Affiliation(s)
- Jessica L Montoya
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brook Henry
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- HIV Neurobehavioral Research Program, San Diego, CA, USA.
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Staff and Organizational Capacity in the Implementation of Coordinated Care: an Examination of 10 Behavioral Health Agencies in Rural Communities. J Behav Health Serv Res 2020; 47:476-492. [DOI: 10.1007/s11414-020-09708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Matthews EB, Stanhope V. A Help or a Hindrance: The Role of Electronic Health Records in Implementing New Practices in Community Mental Health Clinics. Psychiatr Serv 2020; 71:1065-1068. [PMID: 32838681 PMCID: PMC7541550 DOI: 10.1176/appi.ps.201900470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Practice innovation requires adequate organizational resources. Electronic health records (EHRs) are a key organizational resource affecting routine practice delivery, although their capacity to support practice innovation in mental health is largely unknown. This study examined the influence of EHR availability on community mental health clinic (CMHC) providers' fidelity to person-centered care planning (PCCP), an emergent practice that integrates person-centered principles into the mental health service planning process. METHODS Participants included direct providers and supervisors implementing PCCP in seven CMHCs. Fidelity to PCCP was measured by using chart reviews of 378 service plans across three time points. Mixed-effects regression models were used to examine the influence of EHR availability on fidelity to PCCP at each time point. RESULTS Findings suggest that EHRs did not influence PCCP delivery at baseline but were positively associated with fidelity postimplementation. CONCLUSIONS EHRs are an organizational resource that can support practice innovation in mental health when paired with clinic-wide implementation efforts.
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Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, New York (Matthews); New York University, Silver School of Social Work, New York (Stanhope)
| | - Victoria Stanhope
- Graduate School of Social Service, Fordham University, New York (Matthews); New York University, Silver School of Social Work, New York (Stanhope)
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Vadiveloo M, Lichtenstein AH, Anderson C, Aspry K, Foraker R, Griggs S, Hayman LL, Johnston E, Stone NJ, Thorndike AN. Rapid Diet Assessment Screening Tools for Cardiovascular Disease Risk Reduction Across Healthcare Settings: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2020; 13:e000094. [PMID: 32762254 DOI: 10.1161/hcq.0000000000000094] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is critical that diet quality be assessed and discussed at the point of care with clinicians and other members of the healthcare team to reduce the incidence and improve the management of diet-related chronic disease, especially cardiovascular disease. Dietary screening or counseling is not usually a component of routine medical visits. Moreover, numerous barriers exist to the implementation of screening and counseling, including lack of training and knowledge, lack of time, sense of futility, lack of reimbursement, competing demands during the visit, and absence of validated rapid diet screener tools with coupled clinical decision support to identify actionable modifications for improvement. With more widespread use of electronic health records, there is an enormous unmet opportunity to provide evidence-based clinician-delivered dietary guidance using rapid diet screener tools that must be addressed. In this scientific statement from the American Heart Association, we provide rationale for the widespread adoption of rapid diet screener tools in primary care and relevant specialty care prevention settings, discuss the theory- and practice-based criteria of a rapid diet screener tool that supports valid and feasible diet assessment and counseling in clinical settings, review existing tools, and discuss opportunities and challenges for integrating a rapid diet screener tool into clinician workflows through the electronic health record.
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Gill E, Dykes PC, Rudin RS, Storm M, McGrath K, Bates DW. Technology-facilitated care coordination in rural areas: What is needed? Int J Med Inform 2020; 137:104102. [PMID: 32179256 PMCID: PMC7603425 DOI: 10.1016/j.ijmedinf.2020.104102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Health is poorer in rural areas and a major challenge is care coordination for complex chronic conditions. The HITECH and 21st Century Cure Acts emphasize health information exchange which underpins activities required to improve care coordination. OBJECTIVE AND METHODS Using semi-structured interviews and surveys, we examined how providers experience electronic health information exchange during care coordination since these Acts were implemented, with a focus on rural settings where health disparities exist. We used a purposive sample that included primary care, acute care hospitals, and community health services in the United States. FINDINGS We identified seven themes related to care coordination and information exchange: 'insufficient trust of data'; 'please respond'; 'just fax it'; 'care plans'; 'needle in the haystack'; 're-documentation'; and 'rural reality'. These gaps were magnified when information exchange was required between unaffiliated electronic health records (EHRs) about shared patients, which was more pronounced in rural settings. CONCLUSION Policy and incentive modifications are likely needed to overcome the observed health information technology (HIT) shortcomings. Rural settings in the United States accentuate problems that can be addressed through international medical informatics policy makers and the implementation and evaluation of interoperable HIT systems.
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Affiliation(s)
- Emily Gill
- Brigham and Women's Hospital and Harvard Medical School, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, 02120-1613, USA.
| | - Patricia C Dykes
- Brigham and Women's Hospital and Harvard Medical School, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, MA 02120-1613, USA.
| | - Robert S Rudin
- Boston Office RAND Corporation, 20 Park Plaza, 9th Floor, Suite 920, Boston, MA 02116, USA.
| | - Marianne Storm
- Faculty of Health Sciences, Department of Public Health, The University of Stavanger, P.O. Box 8600 Forus, N-4036 Stavanger, Norway.
| | - Kelly McGrath
- Clearwater Valley Orofino Health Center, 1055 Riverside Ave, Orofino, ID 83544, USA.
| | - David W Bates
- Brigham and Women's Hospital and Harvard Medical School, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, MA 02120-1613, USA.
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Matthews EB. Whose System is it Anyway? How Clients and Providers Evaluate the Impact of Session EHR Use on Communication in Mental Health Treatment. Community Ment Health J 2020; 56:540-548. [PMID: 31802323 DOI: 10.1007/s10597-019-00511-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
Electronic health records are common in mental health settings. While providers often express concern that in-session computing will damage client-provider communication, some work suggests that clients do not share this worry. As the majority of this research has been conducted in medical settings, less is known about how clients evaluate in session computing in mental health treatment, and whether this pattern of discordance persists in this setting. This study describes and compares the perceived impact of in-session computing on communication in mental health treatment from the clients and provider perspective, and examined sources of variation in client ratings. Thirteen providers and 53 clients participated in this study, representing 53 unique client-provider dyads. Results suggest that providers perceived in-session computing as more harmful to communication than clients. Client ratings varied by race, age and visit type but were not influenced by how often the computer was used during session.
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Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, 113 W. 60th St, New York, NY, 10023, USA.
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Chimowitz H, O'Neill S, Leveille S, Welch K, Walker J. Sharing Psychotherapy Notes with Patients: Therapists' Attitudes and Experiences. SOCIAL WORK 2020; 65:159-168. [PMID: 32236447 DOI: 10.1093/sw/swaa010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/21/2019] [Accepted: 04/08/2019] [Indexed: 06/11/2023]
Abstract
Evidence suggests that the practice of sharing clinicians' notes with patients via online patient portals may increase patient engagement and improve patient-clinician relationships while requiring little change in providers' workflow. Authors examined clinical social workers' experiences and attitudes related to open psychotherapy notes using focus groups and telephone interviews. Twenty-four of 29 eligible therapists agreed to open their notes to patients, and nine participated in this study. Participants were generally positive about their experiences and reported few disruptions to their workload or practice. However, they were hesitant to bring up notes to patients during sessions, and they discussed the benefits of open therapy notes mostly hypothetically. The five therapists who did not share notes worried that open notes would be detrimental to therapeutic relationships, patient well-being, and workflow. However, the concern they discussed most often related to the electronic health record rather than to open notes, because therapy notes are visible to all authorized clinicians as part of the general medical record. Future research is needed to deepen our understanding of the risks and benefits of open psychotherapy notes and to inform development of training programs to support therapists in opening notes.
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Turner JW, Robinson J, Morris E, Oberkircher K, Rios R, Roett M. Resident reflections on resident-patient communication during family medicine clinic visits. PATIENT EDUCATION AND COUNSELING 2020; 103:484-490. [PMID: 31543354 DOI: 10.1016/j.pec.2019.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Residency programs emphasize effective doctor and patient interaction. However, training can be time intensive and logistically challenging. This paper examines a blog providing resident peer feedback and an opportunity to explore how residents think about patient communication. METHODS A grounded theory approach examined peer commenting on doctor patient interactions. Between 2012-2015, at a U.S. East Coast Family Medicine Clinic, 35 family medicine residents were recorded interacting with patients, producing a total of 84 videos which were posted to a blog. Residents reflected on these videos resulting in 356 responses, 3162 meaning units and 211 codes. Codes were grouped into 10 themes. Further analysis explored how residents signaled positive and negative doctor communications-related behavior. RESULTS Most common themes identified were Rapport/Relationship building skills, Negotiating the appointment, and Peer interaction. Most common themes discussed in light of both positive and negative behavior were Education, Use of technology, and Negotiating the appointment. CONCLUSIONS Residents view their communication with patients as more of a transmission of critical information than an opportunity for dialogue. PRACTICE IMPLICATIONS Findings support how online tools can be used for resident reflections. These tools can reveal resident perceptions of salient communication information in a clinical encounter.
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Affiliation(s)
| | - James Robinson
- Department of Communication, University of Dayton, Dayton, USA
| | - Elise Morris
- Department of Family Medicine, MedStar Georgetown University Hospital, Georgetown University Medical Center, Georgetown University, Washington, D.C., USA
| | | | - Rebeca Rios
- Department of Family Medicine, MedStar Georgetown University Hospital, Georgetown University Medical Center, Georgetown University, Washington, D.C., USA
| | - Michelle Roett
- Department of Family Medicine, MedStar Georgetown University Hospital, Georgetown University Medical Center, Georgetown University, Washington, D.C., USA
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do Carmo Alonso CM, de Lima AN, Oggioni BDMP, Teixeira MR, Oliveira EP, Couto MCV, Duarte FJC. Contributions of activity ergonomics to the design of an electronic health record to support collaborative mental care of children and youth: Preliminary results. Work 2020; 65:187-194. [DOI: 10.3233/wor-193048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | - Melissa Ribeiro Teixeira
- Research Group on Public Mental Health Policies, Institute of Psychiatry, UFRJ, Rio de Janeiro, Brazil
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Feasibility, Acceptability, and Adoption of an Inpatient Tobacco Treatment Service at a Safety-Net Hospital: A Mixed-Methods Study. Ann Am Thorac Soc 2020; 17:63-71. [DOI: 10.1513/annalsats.201906-424oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Apfeld JC, Deans KJ. Learning health systems and the future of clinical research. J Pediatr Surg 2020; 55S:51-53. [PMID: 31662193 DOI: 10.1016/j.jpedsurg.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022]
Abstract
Pediatric surgeons are collectively passionate about prioritizing the healthcare needs of children. We contend that this passion is deeply ingrained in how we drive clinical care and influence scientific discovery. Thus, the future of clinical research in our field will be deeply embedded in our history as a "patient-centric" profession. Service to pediatric patients requires an understanding of their needs and expectations, and designing research that acknowledges both. In this article we detail how future pragmatic clinical research will look in the evolving and learning health system.
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Affiliation(s)
- Jordan C Apfeld
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH; Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH; Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
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Gumede-Moyo S, Todd J, Bond V, Mee P, Filteau S. A qualitative inquiry into implementing an electronic health record system (SmartCare) for prevention of mother-to-child transmission data in Zambia: a retrospective study. BMJ Open 2019; 9:e030428. [PMID: 31494616 PMCID: PMC6731929 DOI: 10.1136/bmjopen-2019-030428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the challenges in implementing a Zambian electronic health records (EHR) system labelled 'SmartCare' from diverse stakeholder perspectives in order to improve prevention of mother-to-child transmission (PMTCT) data collection so that SmartCare can be used for clinic performance strengthening and programme monitoring. DESIGN This is a qualitative retrospective study. SETTING AND PARTICIPANTS SmartCare is a Zambian Ministry of Health (MoH)-led project funded by the US Centre for Disease Control and Prevention. Data were collected using in-depth interviews, observations and focus group discussions (FGDs) between September and November 2016. Seventeen in-depth interviews were held with a range of key informants from the MoH and local and international organisations implementing SmartCare. Four data entry observations and three FGDs with 22 pregnant and lactating women seeking PMTCT services were conducted. Data were analysed using a thematic content approach. RESULTS The SmartCare system has evolved from various patient tracking systems into a multifunctional system. There is a burden of information required so that sometimes not all is collected and entered into the database, resulting in poor data quality. Funding challenges impede data collection due to manpower constraints and shortages of supplies. Challenges associated with data collection depend on whether a paper-based or computer-based system is used. There is no uniformity in the data quality verification and submission strategies employed by various IPs. There is little feedback from the EHR system at health facility level, which has led to disengagement as stakeholders do not see the importance of the system. CONCLUSION SmartCare has structural challenges which can be traced from its development. Funding gaps have resulted in staffing and data collection disparities within IPs. The lack of feedback from the system has also led to complacency at the operational level, which has resulted in poor data quality in later years.
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Affiliation(s)
- Sehlulekile Gumede-Moyo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Jim Todd
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia Bond
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- ZAMBART, University of Zambia School of Medicine, Lusaka, Zambia
| | - Paul Mee
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Enhancing Identification and Management of Hospitalized Patients Who Are Malnourished: A Pilot Evaluation of Electronic Quality Improvement Measures. J Acad Nutr Diet 2019; 119:S32-S39. [DOI: 10.1016/j.jand.2019.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Indexed: 01/04/2023]
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Satre DD, Anderson AN, Leibowitz AS, Levine-Hall T, Slome S, Flamm J, Hare CB, McNeely J, Weisner CM, Horberg MA, Volberding P, Silverberg MJ. Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial. Contemp Clin Trials 2019; 84:105833. [PMID: 31446142 PMCID: PMC6760257 DOI: 10.1016/j.cct.2019.105833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care. METHODS The Promoting Access to Care Engagement (PACE) trial currently in process examines the impact of self-administered electronic screening for SUD risk, depression and anxiety in three large Kaiser Permanente Northern California primary care clinics serving over 5000 PWH. Screening uses validated measures (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]; and the Adult Outcomes Questionnaire [AOQ], which includes the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-2]) delivered via three modalities (secure messaging, tablets in waiting rooms, and desktop computers in exam rooms). Results are integrated automatically into the electronic health record. Based on screening results and physician referrals, behavioral health specialists embedded in primary care initiate motivational interviewing- and cognitive behavioral therapy-based brief treatment and link patients to addiction and psychiatry clinics as needed. Analyses examine implementation (screening and treatment rates) and effectiveness (SUD, depression and anxiety symptoms; HIV viral control) outcomes using a stepped-wedge design, with a 12-month intervention phase implemented sequentially in the clinics, and a 24-month usual care period prior to implementation in each clinic functioning as sequential observational phases for comparison. We also evaluate screening and treatment costs and implementation barriers and facilitators. DISCUSSION The study examines innovative, technology-facilitated strategies for improving assessment and treatment in primary care. Results may help to inform substance use, mental health, and HIV services. TRIAL REGISTRATION NCT03217058.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Alexandra N Anderson
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Amy S Leibowitz
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Sally Slome
- Kasier Permanente Oakland Medical Center, 3801 Howe St, Oakland, CA 94611, United States of America
| | - Jason Flamm
- Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave, Sacramento, CA 95825, United States of America
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, 2238 Geary Blvd, San Francisco, CA 94115, United States of America
| | - Jennifer McNeely
- New York University School of Medicine, 550 1st Ave., New York, NY 10016, United States of America
| | - Constance M Weisner
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson, Rockville, MD 20852, United States of America
| | - Paul Volberding
- AIDS Research Institute, University of California San Francisco, San Francisco, CA, 94158, United States of America
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
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Stanhope V, Matthews EB. Delivering person-centered care with an electronic health record. BMC Med Inform Decis Mak 2019; 19:168. [PMID: 31438960 PMCID: PMC6704707 DOI: 10.1186/s12911-019-0897-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/14/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Electronic health records are now widely adopted in medical and behavioral health settings. While they have the potential to improve the quality of care, the research findings on their impact on clinical practice and outcomes have been mixed. This study explores how the electronic health record and its stage of development influenced the implementation of person-centered care planning in community mental health clinics. METHODS The study was set in five community mental health clinics which utilized an EHR and had been trained in person-centered care planning. Using an objective quantitative measure of fidelity, the study examined fidelity to PCCP across time and by stage of EHR development. Data from focus groups, interviews with clinic leaders and consultant reports was analyzed to explore the process of implementation and the role of the electronic health record. RESULTS All clinics demonstrated an overall increase in PCCP fidelity at the conclusion of the study period but there were significant differences in PCCP fidelity among clinics with EHRs in different stages of development. Electronic health records emerged as a significant implementation factor in the qualitative data with clinics being unable to individualize service plans and encountering technical difficulties. Barriers to person-centered care included drop-down boxes and pre-determined outcomes. Clinic responses included customizing their record or developing workarounds. CONCLUSIONS The study demonstrated the need to align the electronic health record with a person-centered approach which includes individualizing information and orienting service plans to personal life goals. The ability of clinics to be able to customize their records and balance the need for unique and aggregate information in the record is critical to improve both the provider experience and the quality of care. TRIAL REGISTRATION Clinicaltrials.gov , NCT02299492 , registered on November 24, 2014.
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Affiliation(s)
- Victoria Stanhope
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Elizabeth B. Matthews
- Graduate School of Service, Fordham University, 113 West 60th Street, New York, NY 10023 USA
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