An Automatic Notification System for Test Results Finalized after Discharge

出院后确定测试结果的自动通知系统

• 批准号: 7773972
• 负责人: Anuj K Dalal
• 金额: $ 16.99万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7773972
• 关键词: Automatic; Notification; System; Test; Results

DESCRIPTION (provided by applicant): Abstract: The transition to the ambulatory setting following hospital discharge is a vulnerable time for patients. One important patient safety concern is failure of responsible providers to reliably follow up test results finalized after a patient is discharged. Such failure can lead to delays in diagnosis, missed treatment opportunities, redundant ordering of tests, and subsequent patient harm. Automated systems that ensure timely notification of these test results to responsible providers have the potential to mitigate these well documented problems and improve health care quality and safety. The goals of this project are to create an information technology-based automatic notification system to prompt responsible physicians of test results finalized after discharge and to evaluate the impact of this system on physician awareness of these test results. In the first phase of this study, the components of the system will be designed. These include 1) a query of all tests whose final results are pending at the time of discharge, 2) a query for the identity and email addresses of the patient's responsible inpatient and ambulatory provider, 3) logic to exclude routinely ordered inpatient tests to avoid provider alert fatigue, 4) automatic email notification of finalized test results to responsible providers once they are available, and 5) documentation of these results in the ambulatory electronic medical record. The system is designed to facilitate timely communication and the creation of a collaborative plan of care among inpatient and outpatient providers during a patient's transition to the ambulatory setting. A cluster randomized controlled trial will be conducted to measure the impact of such a system on physician awareness. To minimize contamination, both inpatient and ambulatory providers will be randomized, and patients will only be enrolled if both responsible physicians are in the same arm of the study. Study subjects will include patients discharged from the inpatient general medicine and cardiology services at Brigham and Women's Hospital. The primary outcome will be awareness of all post-discharge test results among responsible providers. Secondary outcomes will include user satisfaction, awareness of actionable test results (as judged by providers), and whether appropriate actions are subsequently taken in response to these results (based on electronic medical record review). Physician awareness will be determined using an email survey to providers 72 hours after the first finalized test result is available. The primary outcome will be analyzed as the proportion of test results per patient of which a provider is aware using binomial logistic regression. General estimating equations will be used to adjust for patient and physician characteristics and to cluster by physician. Over a six-month study period, 450 patients will be enrolled in order to provide adequate power to detect an improvement in awareness from 40% to 60% of results. The results of this study will inform future efforts to optimize this type of intervention both at BWH and at other institutions trying to solve this important patient safety problem.

描述（申请人提供）：摘要：出院后向门诊环境的过渡是患者的脆弱时间。 一个重要的患者安全关注点是负责任的提供者无法可靠地跟踪患者出院后确定的测试结果。这种失败会导致诊断的延迟，错过的治疗机会，冗余测试和随后的患者伤害。确保及时通知这些测试结果给负责任提供者的自动化系统有可能减轻这些有记录良好的问题并改善医疗保健质量和安全性。该项目的目标是创建一个基于信息技术的自动通知系统，以促使负责任的测试结果医师在出院后完成，并评估该系统对医师对这些测试结果的意识的影响。在本研究的第一阶段，将设计系统的组件。其中包括1）所有测试的查询 患者负责的住院和门诊提供者的地址，3）逻辑以定期订购的住院测试以避免提供商警报疲劳，4）自动电子邮件通知，一旦可用，将最终的测试结果通知给负责任的提供商，5）5）这些结果记录了这些结果。门诊电子病历。该系统旨在促进及时的沟通，并在患者过渡到门诊期间，在住院和门诊提供者之间制定协作计划。将进行群集随机对照试验，以衡量这种系统对医师意识的影响。为了最大程度地减少污染，住院和门诊提供者都将是随机的，并且只有在两位负责任的医生都处于同一研究中，才会招募患者。研究对象将包括在杨百翰和妇女医院出院的患者。主要结果将是对负责任提供者中所有入院后测试结果的认识。次要结果将包括用户满意度，对可行的测试结果的认识（根据提供者的判断）以及是否随后对这些结果采取适当的措施（基于电子病历审查）。医师意识将在第一个最终确定测试结果可用后72小时使用给提供商的电子邮件调查确定。主要结果将被分析为每个患者的测试结果比例，提供者使用二项式逻辑。 回归。一般估计方程将用于调整患者和医师特征，并通过医师聚类。在一个六个月的研究期内，将招募450名患者，以提供足够的能力来检测其意识从40％增加到60％的结果。这项研究的结果将为未来的努力提供优化在BWH和其他机构的干预措施，以解决这一重要的患者安全问题。