Use of an Electronic Problem List by Primary Care Providers and Specialists

Wright, Adam; Feblowitz, Joshua; Maloney, Francine L.; Henkin, Stanislav; Bates, David W.

doi:10.1007/s11606-012-2033-5

Cited by 28 publications

(19 citation statements)

References 9 publications

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“…Previous literature has suggested that primary care providers are responsible for the majority of problem documentation in the EHR. 35 We attempted to control for many potential factors however, as with all observational studies, we cannot account for residual confounding and true severity of illness. We had a relatively short follow-up time for the ESRD outcome (median of 1.9 years) and perhaps a longer follow-up time is needed to demonstrate the impact of changes in healthcare processes.…”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Jolly¹,

Navaneethan

Schold

et al. 2014

Am J Nephrol

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Background: Whether chronic kidney disease (CKD) recognition in an electronic health record (EHR) problem list improves processes of care or clinical outcomes of end-stage renal disease (ESRD) and death is unclear. Methods: We identified patients who had at least 1 year of follow-up (2005-2009) in our EHR-based CKD registry (n = 25,742). CKD recognition was defined by having ICD-9 codes for CKD, diabetic kidney disease, or hypertensive kidney disease in the problem list. We calculated proportions of patients with and without CKD recognition and examined differences by demographics, clinical factors, and development of ESRD or mortality. We evaluated differences in the proportion of patients with CKD-specific laboratory results checked before and after recognition among cases and propensity-matched controls. Results: Only 11% (n = 2,735) had CKD recognition in the problem list and they were younger (68 vs. 71 years), a higher proportion were male (61 vs. 37%) and African-American (21 vs. 10%) compared to those unrecognized. CKD-specific laboratory results for patients with estimated glomerular filtration rate (eGFR) 30-59 including intact parathyroid hormone (23 vs. 6%), vitamin D (22 vs. 18%), phosphorus (29 vs. 7%), and a urine check for proteinuria (55 vs. 36%) were significantly more likely to be done among those with CKD recognition (all p < 0.05). Similar results were found for eGFR <30 except for proteinuria and in our propensity score-matched control analysis. There was no independent association of CKD recognition with ESRD or mortality. Conclusions: CKD recognition in the EHR problem list was low, but translated into more CKD-specific processes of care; however ESRD or mortality were not affected.

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Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Jolly¹,

Navaneethan

Schold

et al. 2014

Am J Nephrol

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“…Analysis of a random selection of 100,000 medical records demonstrated that PCPs were more likely to add problems to the PL than specialists. 22 Accuracy and completeness of the PL remain major issues. 15,17 For example, PL completeness for diabetes patients was measured in a retrospective analysis of EHR data from 10 healthcare facilities (e.g., academic medical center, community hospital, and regional health system).…”

Section: Emergence Of the Electronic Problem Listmentioning

confidence: 99%

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

et al. 2019

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Objective To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. Methods We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline. Results We identified five goals of the PL (to document the patient's problems, to make sense of the patient's problems, to make decisions about the care plan, to know who is involved in the patient's care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians' suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information. Conclusion Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patient's electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patient's immediate problems.

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“…However, much work remains to ensure that information is consistently collected in a useful format for analysis. 139 For example, improving the accuracy of the problem list in EHRs is a clinically important research area, 140 with implications for examining comprehensiveness of care as well as controlling for patient mix in analysis of outcomes. Better aggregated data across providers could also help us understand how primary care practices that exemplify the five primary care features affect care delivered by specialists.…”

Section: Priorities For Future Data and Researchmentioning

confidence: 99%

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

et al. 2015

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Primary care plays a central role in the provision of health care, and is an organizing feature for health care delivery systems in most Western industrialized democracies. For a variety of reasons, however, the practice of primary care has been in decline in the U.S. This paper reviews key primary care concepts and their definitions, notes the increasingly complex interplay between primary care and the broader health care system, and offers research priorities to support future measurement, delivery and understanding of the role of primary care features on health care costs and quality.

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Use of an Electronic Problem List by Primary Care Providers and Specialists

Cited by 28 publications

References 9 publications

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

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