EHR use and care coordination

EHR 使用和护理协调

基本信息

批准号：
8262141
负责人：
Ilana Graetz
金额：
$ 4.13万
依托单位：
UNIVERSITY OF CALIFORNIA BERKELEY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-01 至 2012-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8262141
关键词：
EHR use care coordination

项目摘要

DESCRIPTION (provided by applicant): While Electronic Health Records (EHR) systems have been consistently promoted as a policy priority for improving the quality and efficiency of the American healthcare system, there is limited research evidence to inform policy-makers about the effects of EHR use on care coordination. This study will use a quasi- experimental design with concurrent controls to evaluate the impact of outpatient physician use of a newly implemented, certified EHR system in Kaiser Permanente Northern California (KPNC) on measures of care coordination, and in turn the association between care coordination and care quality for patients receiving care from multiple clinicians. The study includes all 110 primary care teams in 18 medical centers within the KPNC delivery system, which served over 2 million adult patients (age 18+) between 2005 and 2008. Using multivariate regression analysis, I will examine the association between EHR use and care coordination, while adjusting for clinician characteristics and organizational factors. Additionally, I will examine whether the association between EHR use and care coordination varies by team climate. Finally, I will assess the association between care coordination and clinical care. Measures of care coordination and team climate will be captured using existing self-administered survey responses collected from primary care clinicians in 2005, 2006, and 2008 during the staggered implementation of the EHR system. Quality and clinical outcome measures will be captured using the health system's automated databases and will include guideline-adherent prescription drug use and laboratory monitoring, and physiologic disease control (measured by laboratory tests) for diabetes patients receiving care from multiple clinicians. This study leverages existing data, including survey responses that capture detailed measures of clinician reported care coordination and team climate at multiple points in time as well as the substantial data resources from the study setting. In addition, the staggered nature of the EHR implementation allows for adjustment of secular changes. The 2009 stimulus bill allocated billions of dollars to promote the adoption and meaningful use of EHR. In fact, the definition of meaningful use was specifically designed to target care coordination and care quality. This study will provide important evidence on the role of EHR use on care coordination and quality improvement that are broadly applicable across the nation. In the current clinical environment, where care provided to patients is increasingly fragmented, and also increasingly complex, effective care coordination is essential. Health Information Technology, and specifically EHR, offer new opportunities for improving overall quality of care, preventing medical errors, and reducing health care costs. PUBLIC HEALTH RELEVANCE: The aim of this study is to evaluate the impact of Electronic Health Records (EHR) use on clinician reported measures of care coordination, and in turn the association between care coordination and clinical care for patients with complex care needs. This study will provide important evidence on the role of EHR use on care coordination and quality improvement that are broadly applicable across the nation. In the current clinical environment, where care provided to patients is increasingly fragmented, and also increasingly complex, effective care coordination is essential.

描述（由申请人提供）：尽管电子健康记录（EHR）系统一直被促进作为提高美国医疗保健系统质量和效率的政策优先事项，但研究证据有限，可以为决策者提供有关EHR使用对护理协调的影响的信息。这项研究将使用与并发控制的定准设计，以评估门诊医师在Kaiser Permanente Northerente Northerente（KPNC）中使用新实施的，经过认证的EHR系统对护理协调的度量的影响，而这反过来又是从多个临床医生那里接受护理质量的护理质量的关联。该研究包括KPNC分娩系统中18个医疗中心的所有110个初级保健团队，在2005年至2008年之间为2000多名成年患者（18岁以上）服务。使用多元回归分析，我将研究EHR使用和护理协调之间的关联，同时调整临床特征和组织因素和组织因素。此外，我将检查EHR使用与护理协调之间的关联是否随团队气氛而变化。最后，我将评估护理协调与临床护理之间的关联。在EHR系统交错实施期间，将使用从初级保健临床医生那里收集的现有自我管理的调查反应来捕获护理协调和团队气候的度量。将使用卫生系统的自动数据库来捕获质量和临床结果指标，并将包括准则遵守处方药物使用和实验室监测，以及对从多个临床医生接受护理的糖尿病患者的生理疾病控制（通过实验室检查测量）。这项研究利用现有数据，包括捕获临床医生的详细度量的调查答复，报告了多个时间点的护理协调和团队气候，以及研究环境中的大量数据资源。此外，EHR实施的交错性质可以调整世俗变化。 2009年的刺激法案分配了数十亿美元，以促进EHR的采用和有意义的使用。实际上，有意义使用的定义是专门设计用于针对护理协调和护理质量的。这项研究将提供有关EHR使用在全国范围内广泛适用的EHR在护理协调和质量改进中的作用的重要证据。在当前的临床环境中，为患者提供的护理越来越分散，并且越来越复杂，有效的护理协调至关重要。健康信息技术，尤其是EHR，为改善总体护理质量，防止医疗错误和降低医疗保健成本提供了新的机会。公共卫生相关性：本研究的目的是评估电子健康记录（EHR）对临床医生报告的护理协调措施的影响，进而对具有复杂护理需求的患者的护理协调与临床护理之间的关联。这项研究将提供有关EHR使用在全国范围内广泛适用的EHR在护理协调和质量改进中的作用的重要证据。在当前的临床环境中，为患者提供的护理越来越分散，并且越来越复杂，有效的护理协调至关重要。