Int J Med Inform - Does e-pain plan improve management of sickle cell disease associated vaso-occlusive pain crisis? a mixed methods evaluation.

Tópicos

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Resumo

RPOSE: There is limited application and evaluation of health information systems in the management of vaso-occlusive pain crises in sickle cell disease (SCD) patients. This study evaluates the impact of digitization of paper-based individualized pain plans on process efficiency and care quality by examining both objective patient data and subjective clinician insights.METHODS: Retrospective, before and after, mixed methods evaluation of digitization of paper documents in Children's Hospital of Pittsburgh of UPMC. Subjective perceptions are analyzed using surveys completed by 115 clinicians in emergency department (ED) and inpatient units (IP). Objective effects are evaluated using mixed models with data on 1089 ED visits collected via electronic chart review 28 months before and 22 months after the digitization.RESULTS: Surveys indicate that all clinicians perceived the digitization to improve the efficiency and quality of pain management. Physicians overwhelmingly preferred using the digitized plans, but only 44% of the nurses had the same response. Analysis of patient records indicates that adjusted time from analgesic order to administration was significantly reduced from 35.50 to 26.77 min (p<.05). However, time to first dose and some of the objective quality measures (time from administration to relief, relief rate, admission rate, and ED re-visit rate) were not significantly affected.DISCUSSION: The relatively simple intervention, high baseline performance, and limited accommodation of nurses' perspectives may account for the marginal improvements in process efficiency and quality outcomes. Additional efforts, particularly improved communication between physicians and nurses, are needed to further enhance quality of pain management.CONCLUSION: This study highlights the important role of health information technology (HIT) on vaso-occlusive pain management for pediatric patients with sickle cell disease and the critical challenges in accommodating human factor considerations in implementing and evaluating HIT effects.

Resumo Limpo

rpose limit applic evalu health inform system manag vasoocclus pain crise sickl cell diseas scd patient studi evalu impact digit paperbas individu pain plan process effici care qualiti examin object patient data subject clinician insightsmethod retrospect mix method evalu digit paper document children hospit pittsburgh upmc subject percept analyz use survey complet clinician emerg depart ed inpati unit ip object effect evalu use mix model data ed visit collect via electron chart review month month digitizationresult survey indic clinician perceiv digit improv effici qualiti pain manag physician overwhelm prefer use digit plan nurs respons analysi patient record indic adjust time analges order administr signific reduc min p howev time first dose object qualiti measur time administr relief relief rate admiss rate ed revisit rate signific affecteddiscuss relat simpl intervent high baselin perform limit accommod nurs perspect may account margin improv process effici qualiti outcom addit effort particular improv communic physician nurs need enhanc qualiti pain managementconclus studi highlight import role health inform technolog hit vasoocclus pain manag pediatr patient sickl cell diseas critic challeng accommod human factor consider implement evalu hit effect

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