J Am Med Inform Assoc - The marginal value of pre-visit paper reminders when added to a multifaceted electronic health record based quality improvement system.

Tópicos

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Resumo

JECTIVE: We have reported that implementation of an electronic health record (EHR) based quality improvement system that included point-of-care electronic reminders accelerated improvement in performance for multiple measures of chronic disease care and preventive care during a 1-year period. This study examined whether providing pre-visit paper quality reminders could further improve performance, especially for physicians whose performance had not improved much during the first year.DESIGN: Time-series analysis at a large internal medicine practice using a commercial EHR. All patients eligible for each measure were included (range approximately 100-7500).MEASUREMENTS: The proportion of eligible patients in the practice who satisfied each of 15 quality measures after removing those with exceptions from the denominator. To analyze changes in performance for individual physicians, two composite measures were used: prescribing seven essential medications and completion of five preventive services.RESULTS: During the year after implementing pre-encounter reminders, performance continued to improve for eight measures, remained stable for four, and declined for three. Physicians with the worst performance at the start of the pre-encounter reminders showed little absolute improvement over the next year, and most remained below the median performance for physicians in the practice.CONCLUSIONS: Paper pre-encounter reminders did not appear to improve performance beyond electronic point-of-care reminders in the EHR alone. Lagging performance is likely not due to providers' EHR workflow alone, and trying to step backwards and use paper reminders in addition to point-of-care reminders in the EHR may not be an effective strategy for engaging slow adopters.

Resumo Limpo

jectiv report implement electron health record ehr base qualiti improv system includ pointofcar electron remind acceler improv perform multipl measur chronic diseas care prevent care year period studi examin whether provid previsit paper qualiti remind improv perform especi physician whose perform improv much first yeardesign timeseri analysi larg intern medicin practic use commerci ehr patient elig measur includ rang approxim measur proport elig patient practic satisfi qualiti measur remov except denomin analyz chang perform individu physician two composit measur use prescrib seven essenti medic complet five prevent servicesresult year implement preencount remind perform continu improv eight measur remain stabl four declin three physician worst perform start preencount remind show littl absolut improv next year remain median perform physician practiceconclus paper preencount remind appear improv perform beyond electron pointofcar remind ehr alon lag perform like due provid ehr workflow alon tri step backward use paper remind addit pointofcar remind ehr may effect strategi engag slow adopt

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