急诊医学随访在实现闭环沟通和下游随访中的有效性

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine Pub Date : 2025-04-09 DOI:10.1016/j.ajem.2025.04.020

Jorge Fradinho PhD MENG MS , Maria Cadman BSN RN , Ryan C. Burke PhD, MPH , Maxwell Blodgett MD , Richard Wolfe MD , Jayson Carr MD , Shamai Grossman MD MS

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引用次数: 0

摘要

不同的电子健康记录（EHR）的使用阻碍了急诊医学（EM）和初级保健提供者（PCP）之间的沟通，因此需要研究EM在患者出院后实现护理连续性方面的有效性。本研究的目的是评估EM-based随访计划的有效性，该计划使用安全电子邮件进行EM出院后的闭环沟通和意外发现（IF）随访。方法回顾性分析9月1日~ 21日2个急诊科（ED）和1个急诊科的IFs。前一天的IFs由EM质量保证（QA）团队确定，然后通过电子邮件通知患者的PCP。基于规则的电子邮件自动自然语言处理（NLP），将数据链接到电子病历。结果的图表回顾包括是否建立了闭环沟通（通过确认IF收到的PCP回复）以及是否在12个月内进行了随访。多元逻辑回归模型检查了与每个结果相关的因素。结果在1781例IF报告中，62%为女性，77%为白人，91%为英语。PCP回答39.1%；最终随访率为64.9%。患者和IF特征与PCP应答无关。PCP任期和EM/PCP EHR系统一致性与PCP回复的调整优势比（aOR）较高相关（aOR为1.05 [1.04-1.07]vs . 2.6[2.0-3.3]）。实验室干扰素随访率高于影像学干扰素随访率（aOR 1.94[1.46-2.6]）。EM/PCP使用相同的电子病历与某种形式随访的更高几率相关（aOR: 2.1[1.7-2.7]）。结论虽然电子邮件通知和使用相同的电子病历提高了护理的连续性，但它们本身是不够的。需要更全面的解决方案来实现EM-PCP沟通和患者随访。

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The effectiveness of emergency medicine follow-up in attaining closed loop communication and downstream follow-up

Background

Utilization of different Electronic Health Records (EHR) impedes communication between Emergency Medicine (EM) and Primary Care Provider (PCP) necessitating study on EM's effectiveness in enabling continuity of care following patient discharge. This study's objective was to evaluate the effectiveness of an EM-based follow-up program using secure email for closed-loop communication and follow-up of incidental findings (IF) after EM discharge.

Methods

Retrospective study of IFs from two Emergency Departments (ED) and one urgent care between 9/1/20–8/30/21. Preceding day IFs were identified by an EM Quality Assurance (QA) team who then notified the patient's PCP via email. Automated rules-based natural language processing (NLP) of emails linking data to EHRs. Chart reviewing of outcomes included whether closed loop communication was established (via a PCP reply acknowledging IF receipt) and whether follow-up care occurred within 12 months. Multivariate logistic regression models examined factors associated with each outcome.

Results

Of 1781 IF notifications, 62 % were female, 77 % white, and 91 % English speaking. PCP replied to 39.1 %; 64.9 % were ultimately followed-up. Patient and IF characteristics were not associated with PCP reply. PCP tenure and EM/PCP EHR system concordance were associated with higher adjusted Odds Ratio (aOR) of PCP reply (aOR 1.05 [1.04–1.07] vs 2.6 [2.0–3.3]). Laboratory IFs were followed-up more than imaging IFs (aOR 1.94 [1.46–2.6]). EM/PCP Use of same EHR was associated with higher odds of some form of follow-up (aOR: 2.1 [1.7–2.7]).

Conclusions

While email notifications and using the same EHR improve continuity of care, they are insufficient on their own. More comprehensive solutions are needed to enable EM-PCP communication and patient follow-up.

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来源期刊

American Journal of Emergency Medicine 医学-急救医学

CiteScore

6.00

自引率

5.60%

发文量

730

审稿时长

42 days

期刊介绍： A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.