Primary care physician attitudes concerning follow-up of abnormal test results and ambulatory decision support systems

Vanderbilt University, Нашвилл, Michigan, United States
International Journal of Medical Informatics (Impact Factor: 2). 10/2003; 71(2-3):137-49. DOI: 10.1016/S1386-5056(03)00133-3
Source: PubMed


Failures to follow-up abnormal test results are common in ambulatory care. Information systems could assist providers with abnormal test result tracking, yet little is known about primary care providers attitudes toward outpatient decision support systems.
A cross-sectional survey of 216 primary care physicians (PCPs) that utilize a single electronic medical record (EMR) without computer-based clinical decision support.
The overall response rate was 65% (140/216). Less than one-third of the respondents were satisfied with their current system to manage abnormal laboratory, radiographs, Pap smear, or mammograms results. Only 15% of providers were satisfied with their system to notify patients of abnormal results. Over 90% of respondents felt automated systems to track abnormal test results would be useful. Seventy-nine percent of our respondents believed that they could comply better with guidelines through electronic clinical reminders.
Most PCPs were not satisfied with their methods for tracking abnormal results. Respondents believed that clinical decision support systems (CDSS) would be useful and could improve their ability to track abnormal results.

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    • "Survey development was guided by literature review1 6 21–34 and by a conceptual model describing multiple inter-related dimensions of EHR use (see ‘Survey content areas’ section below; also see table 1 which lists model dimensions).35 A psychometrician (CS) guided the survey development process, which included item writing and refinement, soliciting input from subject matter experts in EHR use, and iterative content review. "
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    ABSTRACT: Context Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system. Methods Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use. Findings Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient's next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications. Conclusions Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere.
    Journal of the American Medical Informatics Association 12/2012; 20(4). DOI:10.1136/amiajnl-2012-001267 · 3.50 Impact Factor
    • "Failure to follow up test results is a critical safety issue which has been identified as a major problem in ambulatory settings.1–4 The practices and processes currently used are varied and unsystematic2,5 and physicians6,7 and patients8,9 acknowledge that this needs to improve. The testing process in ambulatory settings is complex and can be divided into three broad phases, pre-analytic, analytic and post-analytic (Fig. 1), each involving multiple steps and multiple personnel including clinicians, patients, office and laboratory staff.10 "
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    ABSTRACT: Serious lapses in patient care result from failure to follow-up test results. To systematically review evidence quantifying the extent of failure to follow-up test results and the impact for ambulatory patients. Medline, CINAHL, Embase, Inspec and the Cochrane Database were searched for English-language literature from 1995 to 2010. Studies which provided documented quantitative evidence of the number of tests not followed up for patients attending ambulatory settings including: outpatient clinics, academic medical or community health centres, or primary care practices. Four reviewers independently screened 768 articles. Nineteen studies met the inclusion criteria and reported wide variation in the extent of tests not followed-up: 6.8% (79/1163) to 62% (125/202) for laboratory tests; 1.0% (4/395) to 35.7% (45/126) for radiology. The impact on patient outcomes included missed cancer diagnoses. Test management practices varied between settings with many individuals involved in the process. There were few guidelines regarding responsibility for patient notification and follow-up. Quantitative evidence of the effectiveness of electronic test management systems was limited although there was a general trend towards improved test follow-up when electronic systems were used. Most studies used medical record reviews; hence evidence of follow-up action relied upon documentation in the medical record. All studies were conducted in the US so care should be taken in generalising findings to other countries. Failure to follow-up test results is an important safety concern which requires urgent attention. Solutions should be multifaceted and include: policies relating to responsibility, timing and process of notification; integrated information and communication technologies facilitating communication; and consideration of the multidisciplinary nature of the process and the role of the patient. It is essential that evaluations of interventions are undertaken and solutions integrated into the work and context of ambulatory care delivery.
    Journal of General Internal Medicine 12/2011; 27(10):1334-48. DOI:10.1007/s11606-011-1949-5 · 3.42 Impact Factor
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    • "The users' views on data systems are important for the real-term prospects of disseminating such tools. Doctors appreciate structured recording [22, 23]. Nurses' views on electronic patient records have been studied at a major hospital in Florida [24]. "
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    ABSTRACT: Background. Nursing homes face challenges in the coming years due to the increased number of elderly. Quality will be under pressure, expectations of the services will rise, and clinical complexity will grow. New strategies are needed to meet this situation. Modern clinical information systems with decision support may be part of that. Objectives. To study the impact of introducing an electronic patient record system with decision support on the use of warfarin, neuroleptics and weighing of patients, in nursing homes. Methods. A prevalence study was performed in seven nursing homes with 513 subjects. A before-after study with internal controls was performed. Results. The prevalence of atrial fibrillation in the seven nursing homes was 18.8%. After intervention, the proportion of all patients taking warfarin increased from 3.0% to 9.8% (P = 0.0086), neuroleptics decreased from 33.0% to 21.5% (P = 0.0121), and the proportion not weighed decreased from 72.6% to 16.0% (P < 0.0001). The internal controls did not change significantly. Conclusion. Statistics and management data can be continuously produced to monitor the quality of work processes. The electronic health record system and its system for decision support can improve drug therapy and monitoring of treatment policy.
    10/2011; 2011:208142. DOI:10.5402/2011/208142
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