America's “Undiscovered” Laboratory for Health Services Research

Gimbel, Ronald W.; Pangaro, Louis N.; Barbour, Galen L.

doi:10.1097/mlr.0b013e3181e35be8

Cited by 51 publications

(65 citation statements)

References 12 publications

(15 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The MHS is a large capitated health system, comparable to several of the large managed care health systems in operation within the United States (e.g., Kaiser Permanente®, Partners™ Healthcare). The MHS cares for more than 9 million beneficiaries, provides approximately 34 million visits annually [23] and is representative of American society with regard to patient demographics, common diagnoses, and medical procedures [24]. The health system includes both direct care delivery and a defined benefit (i.e., TRICARE).…”

Section: Methodsmentioning

confidence: 99%

Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research

Hanson

Stephens

Pangaro

et al. 2012

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundThere are no empirically-grounded criteria or tools to define or benchmark the quality of outpatient clinical documentation. Outpatient clinical notes document care, communicate treatment plans and support patient safety, medical education, medico-legal investigations and reimbursement. Accurately describing and assessing quality of clinical documentation is a necessary improvement in an increasingly team-based healthcare delivery system. In this paper we describe the quality of outpatient clinical notes from the perspective of multiple stakeholders.MethodsUsing purposeful sampling for maximum diversity, we conducted focus groups and individual interviews with clinicians, nursing and ancillary staff, patients, and healthcare administrators at six federal health care facilities between 2009 and 2011. All sessions were audio-recorded, transcribed and qualitatively analyzed using open, axial and selective coding.ResultsThe 163 participants included 61 clinicians, 52 nurse/ancillary staff, 31 patients and 19 administrative staff. Three organizing themes emerged: 1) characteristics of quality in clinical notes, 2) desired elements within the clinical notes and 3) system supports to improve the quality of clinical notes. We identified 11 codes to describe characteristics of clinical notes, 20 codes to describe desired elements in quality clinical notes and 11 codes to describe clinical system elements that support quality when writing clinical notes. While there was substantial overlap between the aspects of quality described by the four stakeholder groups, only clinicians and administrators identified ease of translation into billing codes as an important characteristic of a quality note. Only patients rated prioritization of their medical problems as an aspect of quality. Nurses included care and education delivered to the patient, information added by the patient, interdisciplinary information, and infection alerts as important content.ConclusionsPerspectives of these four stakeholder groups provide a comprehensive description of quality in outpatient clinical documentation. The resulting description of characteristics and content necessary for quality notes provides a research-based foundation for assessing the quality of clinical documentation in outpatient health care settings.

show abstract

Section: Methodsmentioning

confidence: 99%

Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research

Hanson

Stephens

Pangaro

et al. 2012

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…A potential study limitation is that its patient population was drawn from consecutive heart failure patients seen at one heart failure clinic, but we believe that these patients are representative of heart failure patients [34–37]. Another potential limitation is the relatively small number of clinicians, but we believe that the clinicians were representative of heart failure clinicians.…”

Section: Discussionmentioning

confidence: 99%

Assessing the usability by clinicians of VISION: A hierarchical display of patient-collected physiological information to clinicians

Gardner

Liu

Fontelo

et al. 2017

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

BackgroundThe inability of patients to accurately and completely recount their clinical status between clinic visits reduces the clinician’s ability to properly manage their patients. One way to improve this situation is to collect objective patient information while the patients are at home and display the collected multi-day clinical information in parallel on a single screen, highlighting threshold violations for each channel, and allowing the viewer to drill down to any analog signal on the same screen, while maintaining the overall physiological context of the patient. All this would be accomplished in a way that was easy for the clinician to view and use.MethodsPatients used five mobile devices to collect six heart failure-related clinical variables: body weight, systolic and diastolic blood pressure, pulse rate, blood oxygen saturation, physical activity, and subjective input. Fourteen clinicians practicing in a heart failure clinic rated the display using the System Usability Scale that, for acceptability, had an expected mean of 68 (SD, 12.5). In addition, we calculated the Intraclass Correlation Coefficient of the clinician responses using a two-way, mixed effects model, ICC (3,1).ResultsWe developed a single-screen temporal hierarchical display (VISION) that summarizes the patient’s home monitoring activities between clinic visits. The overall System Usability Scale score was 92 (95% CI, 87-97), p < 0.0001; the ICC was 0.89 (CI, 0.79-0.97), p < 0.0001.ConclusionClinicians consistently found VISION to be highly usable. To our knowledge, this is the first single-screen, parallel variable, temporal hierarchical display of both continuous and discrete information acquired by patients at home between clinic visits that presents clinically significant information at the point of care in a manner that is usable by clinicians.

show abstract

“…An independent contractor blinded to the study selected the notes of 537 type 2 diabetic outpatients who were treated by physicians at five U.S. Military Health System (MHS) outpatient primary care clinics. The MHS’s commercial EHR is similar to most EHRs and the MHS population is similar to the general population 14–17. The patients had to have been seen on at least three occasions: once approximately six months prior to EHR adoption (before-EHR), once approximately six months after EHR adoption (after-EHR) and once approximately five years after EHR adoption (five-years), for a total of 1611 notes.…”

Section: Methodsmentioning

confidence: 99%

The adoption of an electronic health record did not improve A1c values in Type 2 diabetes

Burke

Becher

Hoang

et al. 2016

jhi

View full text Add to dashboard Cite

AbsTrAcTbackground A major justification for the clinical adoption of electronic health records (EHRs) was the expectation that it would improve the quality of medical care. No longitudinal study has tested this assumption. Objective We used hemoglobin A1c, a recognized clinical quality measure directly related to diabetes outcomes, to assess the effect of EHR use on clinical quality. Methods We performed a five-and-one-half-year multicentre longitudinal retrospective study of the A1c values of 537 type 2 diabetic patients. The same patients had to have been seen on at least three occasions: once approximately six months prior to EHR adoption (before-EHR), once approximately six months after EHR adoption (after-EHR) and once approximately five years after EHR adoption (five-years), for a total of 1,611 notes. results The overall mean confidence interval (CI) A1c values for the before-EHR, after-EHR and five-years were 7.07 (6.91 -7.23), 7.33 (7.14 -7.52) and 7.19 (7.06 -7.32), respectively. There was a small but significant increase in A1c values between before-EHR and after-EHR, p = .04; there were no other significant differences. There was a significant decrease in notes missing at least one A1c value, from 42% before-EHR to 16% five-years (p < .001). conclusion We found that based on patient's A1c values, EHRs did not improve the clinical quality of diabetic care in six months and five years after EHR adoption. To our knowledge, this is the first longitudinal study to directly assess the relationship between the use of an EHR and clinical quality.

show abstract

America's “Undiscovered” Laboratory for Health Services Research

Cited by 51 publications

References 12 publications

Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research

Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research

Assessing the usability by clinicians of VISION: A hierarchical display of patient-collected physiological information to clinicians

The adoption of an electronic health record did not improve A1c values in Type 2 diabetes

Contact Info

Product

Resources

About