BMC Med Inform Decis Mak - Evaluating the impact of patients' online access to doctors' visit notes: designing and executing the OpenNotes project.

Tópicos

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Resumo

CKGROUND: Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes would not lead to significant disruptions to doctors' practices.METHODS/DESIGN: Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; the third used an experimental portal. We targeted 3 key areas where we hypothesized the greatest impacts: beliefs and attitudes about OpenNotes, use of the patient internet portals, and patient-doctor communication. PCPs in the 3 sites were invited to participate in the intervention. Patients who were registered portal users of participating PCPs were given access to their PCPs' visit notes for one year. PCPs who declined participation in the intervention and their patients served as the comparison groups for the study. We applied the RE-AIM framework to our design in order to capture as comprehensive a picture as possible of the impact of OpenNotes. We developed pre- and post-intervention surveys for online administration addressing attitudes and experiences based on interviews and focus groups with patients and doctors. In addition, we tracked use of the internet portals before and during the intervention.RESULTS: PCP participation varied from 19% to 87% across the 3 sites; a total of 114 PCPs enrolled in the intervention with their 22,000 patients who were registered portal users. Approximately 40% of intervention and non-intervention patients at the 3 sites responded to the online survey, yielding a total of approximately 38,000 patient surveys.DISCUSSION: Many primary care physicians were willing to participate in this "real world" experiment testing the impact of OpenNotes on their patients and their practices. Results from this trial will inform providers, policy makers, and patients who contemplate such changes at a time of exploding interest in transparency, patient safety, and improving the quality of care.

Resumo Limpo

ckground provid policymak pursu strategi increas patient engag health care increas onlin section medic record viewabl patient though seldom clinician visit note includ design oneyear multisit trial onlin patient access offic visit note opennot hypothes patient primari care physician pcps want continu opennot lead signific disrupt doctor practicesmethodsdesign use mix method approach design quasiexperiment studi divers healthcar system boston pennsylvania seattl two site exist patient internet portal third use experiment portal target key area hypothes greatest impact belief attitud opennot use patient internet portal patientdoctor communic pcps site invit particip intervent patient regist portal user particip pcps given access pcps visit note one year pcps declin particip intervent patient serv comparison group studi appli reaim framework design order captur comprehens pictur possibl impact opennot develop pre postintervent survey onlin administr address attitud experi base interview focus group patient doctor addit track use internet portal interventionresult pcp particip vari across site total pcps enrol intervent patient regist portal user approxim intervent nonintervent patient site respond onlin survey yield total approxim patient surveysdiscuss mani primari care physician will particip real world experi test impact opennot patient practic result trial will inform provid polici maker patient contempl chang time explod interest transpar patient safeti improv qualiti care

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