使用环境AI抄写器减少管理负担和职业倦怠。

IF 9.7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Kristine D Olson, Daniella Meeker, Matt Troup, Timothy D Barker, Vinh H Nguyen, Jennifer B Manders, Cheryl D Stults, Veena G Jones, Sachin D Shah, Tina Shah, Lee H Schwamm
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引用次数: 0

摘要

重要性:在供不应求的情况下,门诊医生花在管理任务和电子健康记录文档上的时间比花在直接病人护理上的时间要多,这与职业倦怠、离职意向和护理质量下降有关。目的:探讨环境人工智能记录仪是否与减轻临床医生的行政负担和职业倦怠有关。设计、设置和参与者:本质量改进研究使用干预前和干预后30天的调查来评估在美国6个学术和社区卫生保健系统的门诊护理医生和高级实践从业人员中使用相同的环境人工智能平台进行临床记录记录。临床医生由卫生系统的数字卫生负责人招募;参与是自愿的。该研究于2024年2月1日至10月31日进行。暴露:使用环境AI脚本30天。主要结局和测量:主要结局是自我报告的倦怠改变,使用分层逻辑回归估计。倦怠评估的次要结果是笔记相关认知任务负荷的变化,对患者的注意力集中,患者对笔记的理解能力,在紧急情况下将患者添加到诊所时间表的能力,以及下班后记录的时间。结果测量线性转换为10分制,以方便解释和比较。采用配对t检验确定干预前和干预后得分的差异。结果:纳入的451名临床医生中,272名完成了干预前和干预后的调查(完成率为60.3%),263名在门诊直接接受患者护理(平均[SD]年,15.1[9.3];141名女性[53.6%])被纳入分析。样本包括131名初级保健医生(49.7%)、232名主治医生(88.2%)和168名学术教师(63.9%)。使用环境人工智能30天后,经历过倦怠的参与者比例从51.9%显著下降到38.8%(优势比0.26;95% CI, 0.13-0.54)。在10分制量表上,环境人工智能记录仪与以下次要结果显著改善相关:倦怠(平均[SE]差,0.47[0.12]分)、笔记相关认知任务负荷(平均[SE]差,2.64[0.13]分)、集中注意力的能力(平均[SE]差,2.05[0.18]分)、患者通过阅读笔记对护理计划的理解能力(平均[SE]差,-0.44[0.17]分)、如果紧急需要,将患者加入临床计划的能力(平均[SE]差,0.51[0.24]点),以及小时后记录所花费的时间(平均[SE]差,0.90[0.19]小时)。结论和相关性:这项多中心质量改进研究发现,使用环境人工智能记录平台与显著减少倦怠、认知任务负荷和记录时间有关,并且认为它可以改善患者获得护理的机会,并增加对患者在门诊环境中的关注。这些发现表明,人工智能可能有助于减轻临床医生的行政负担,并为有意义的工作和专业福祉腾出更多时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use of Ambient AI Scribes to Reduce Administrative Burden and Professional Burnout.

Importance: While in short supply and high demand, ambulatory care clinicians spend more time on administrative tasks and documentation in the electronic health record than on direct patient care, which has been associated with burnout, intention to leave, and reduced quality of care.

Objective: To examine whether ambient AI scribes are associated with reducing clinician administrative burden and burnout.

Design, setting, and participants: This quality improvement study used preintervention and 30-day postintervention surveys to evaluate the use of the same ambient AI platform for clinical note documentation among ambulatory care physicians and advanced practice practitioners of 6 academic and community-based health care systems across the US. Clinicians were recruited by the health systems' digital health leaders; participation was voluntary. The study was conducted between February 1 and October 31, 2024.

Exposure: Use of an ambient AI scribe for 30 days.

Main outcomes and measures: The primary outcome was change in self-reported burnout, estimated using hierarchical logistic regression. Secondary outcomes of burnout evaluated were changes in note-related cognitive task load, focused attention on patients, patient understandability of notes, ability to add patients to the clinic schedule if urgently needed, and time spent documenting after hours. Outcome measures were linearly transformed to 10-point scales to ease interpretation and comparison. Differences between preintervention and postintervention scores were determined using paired t tests.

Results: Of the 451 clinicians enrolled, 272 completed the preintervention and postintervention surveys (60.3% completion rate), and 263 with direct patient care in ambulatory clinics (mean [SD] years in practice, 15.1 [9.3]; 141 female [53.6%]) were included in the analysis. The sample included 131 primary care practitioners (49.7%), 232 attending physicians (88.2%), and 168 academic faculty (63.9%). After 30 days with the ambient AI scribe, the proportion of participants experiencing burnout decreased significantly from 51.9% to 38.8% (odds ratio, 0.26; 95% CI, 0.13-0.54). On 10-point scales, the ambient AI scribe was associated with significant improvements in secondary outcomes of burnout (mean [SE] difference, 0.47 [0.12] points), note-related cognitive task load (mean [SE] difference, 2.64 [0.13] points), ability to provide undivided attention (mean [SE] difference, 2.05 [0.18] points), patient understandability of their care plans from reading the notes (mean [SE] difference, -0.44 [0.17] points), ability to add patients to the clinic schedule if urgently needed (mean [SE] difference, 0.51 [0.24] points), and time spent documenting after hours (mean [SE] difference, 0.90 [0.19] hours).

Conclusions and relevance: This multicenter quality improvement study found that use of an ambient AI scribe platform was associated with a significant reduction in burnout, cognitive task load, and time spent documenting, as well as the perception that it could improve patient access to care and increase attention on patient concerns in an ambulatory environment. These findings suggest that AI may help reduce administrative burdens for clinicians and allow more time for meaningful work and professional well-being.

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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
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