创建一个操作仪表板,以记录在老年患者为中心的医疗之家的初级保健中4M的实施情况

James Powers, A. McCoy, Shana Rhodes
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引用次数: 0

摘要

许多卫生系统加入了“老年友好型卫生系统”运动,为每一位老年人提供符合最重要内容的安全、高质量的护理。成为一个老年友好型医疗系统意味着医院和医疗保健系统可靠地使用一套被称为“4M”的循证实践——重要的是什么、药物、心理和行动——在所有护理环境中为老年人、残疾人和医疗复杂的患者提供护理。将医疗保健改善研究所(IHI)4M的老年友好原则应用于初级保健是一项挑战,因为没有确定分娩文件的最佳实践。利用电子健康记录(EHR)可以使这一过程自动化。IHI同行辅导网络研讨会讨论了初级保健的年龄友好原则,以及诊所工作人员使用的PDSA周期,以定义范德比尔特老年医学实践的每个4M:1)心理——从护理摄入中提取的Mini COG和PHQ2,2)药物——从药物审查、提供者对账中提取,3)移动性——从日常生活活动(ADL)中提取——护理摄入中的移动性问题,以及4)最重要的是什么——识别患者门户信息。我们的EPIC电子健康记录(EHR)中的仪表板是基于这些确定的字段构建的,允许临床医生根据需要向下搜索以显示更多细节。EHR的操作仪表板有可能帮助临床医生在初级保健环境中提供4M的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Creation of an Operational Dashboard to Document Implementation of 4M’s into Primary Care in a Geriatric Patient-Centered Medical Home
Many health systems have joined the Age-Friendly Health Systems movement to provide every older adult safe, high-quality care aligned with what matters most. Becoming an Age-Friendly Health System means that hospitals and health care systems reliably use a set of evidence-based practices known as the “4M’s” – What Matters, Medication, Mentation, and Mobility – to provide care for older, disabled and medically complex patients across all care settings. Implementing the Institute for Healthcare Improvement’s (IHI) 4M’s Age-Friendly principles into primary care is challenging because there is no best practice to identify documentation of delivery. Leveraging the electronic health record (EHR) may automate this process. Age-Friendly principles for primary care were discussed at IHI peer coaching webinars, and PDSA cycles employed among clinic staff to define each of the 4M’s for the Vanderbilt Geriatric Practice: 1) Mentation – Mini-COG and PHQ2 extracted from nursing intake, 2) Medication – extracted from medication review, provider reconciliation, 3) Mobility – extracted from activities of daily living (ADL) mobility questions in nursing intake, and 4) What Matters Most – identifying patient portal messages. A dashboard within our EPIC electronic health record (EHR) was built based on these identified fields, allowing clinician drill-down to display more detail as needed. An operational dashboard for an EHR has potential to help inform clinician delivery of 4M’s care in the primary care setting.
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