Dataset Information

How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.

ABSTRACT:

Objectives

Electronic health record (EHR)-based alerts can facilitate transmission of test results to healthcare providers, helping ensure timely and appropriate follow-up. However, failure to follow-up on abnormal test results (missed test results) persists in EHR-enabled healthcare settings. We aimed to identify contextual factors associated with facility-level variation in missed test results within the Veterans Affairs (VA) health system.

Design, setting and participants

Based on a previous survey, we categorised VA facilities according to primary care providers' (PCPs') perceptions of low (n=20) versus high (n=20) risk of missed test results. We interviewed facility representatives to collect data on several contextual factors derived from a sociotechnical conceptual model of safe and effective EHR use. We compared these factors between facilities categorised as low and high perceived risk, adjusting for structural characteristics.

Results

Facilities with low perceived risk were significantly more likely to use specific strategies to prevent alerts from being lost to follow-up (p=0.0114). Qualitative analysis identified three high-risk scenarios for missed test results: alerts on tests ordered by trainees, alerts 'handed off' to another covering clinician (surrogate clinician), and alerts on patients not assigned in the EHR to a PCP. Test result management policies and procedures to address these high-risk situations varied considerably across facilities.

Conclusions

Our study identified several scenarios that pose a higher risk for missed test results in EHR-based healthcare systems. In addition to implementing provider-level strategies to prevent missed test results, healthcare organisations should consider implementing monitoring systems to track missed test results.

SUBMITTER: Menon S

PROVIDER: S-EPMC4244393 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Publications

How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.

Menon Shailaja S Smith Michael W MW Sittig Dean F DF Petersen Nancy J NJ Hysong Sylvia J SJ Espadas Donna D Modi Varsha V Singh Hardeep H

BMJ open 20141111 11

<h4>Objectives</h4>Electronic health record (EHR)-based alerts can facilitate transmission of test results to healthcare providers, helping ensure timely and appropriate follow-up. However, failure to follow-up on abnormal test results (missed test results) persists in EHR-enabled healthcare settings. We aimed to identify contextual factors associated with facility-level variation in missed test results within the Veterans Affairs (VA) health system.<h4>Design, setting and participants</h4>Based ...[more]

PMID: 25387758

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Project description:BACKGROUND:Children with health insurance have increased access to healthcare and receive higher quality care. However, despite recent initiatives expanding children's coverage, many remain uninsured. New technologies present opportunities for helping clinics provide enrollment support for patients. We developed and tested electronic health record (EHR)-based tools to help clinics provide children's insurance assistance. METHODS:We used mixed methods to understand tool adoption, and to assess impact of tool use on insurance coverage, healthcare utilization, and receipt of recommended care. We conducted intent-to-treat (ITT) analyses comparing pediatric patients in 4 intervention clinics (n?=?15,024) to those at 4 matched control clinics (n?=?12,227). We conducted effect-of-treatment-on-the-treated (ETOT) analyses comparing intervention clinic patients with tool use (n?=?2240) to intervention clinic patients without tool use (n?=?12,784). RESULTS:Tools were used for only 15% of eligible patients. Qualitative data indicated that tool adoption was limited by: (1) concurrent initiatives that duplicated the work associated with the tools, and (2) inability to obtain accurate insurance coverage data and end dates. The ITT analyses showed that intervention clinic patients had higher odds of gaining insurance coverage (adjusted odds ratio [aOR]?=?1.32, 95% confidence interval [95%CI] 1.14-1.51) and lower odds of losing coverage (aOR?=?0.77, 95%CI 0.68-0.88), compared to control clinic patients. Similarly, ETOT findings showed that intervention clinic patients with tool use had higher odds of gaining insurance (aOR?=?1.83, 95%CI 1.64-2.04) and lower odds of losing coverage (aOR?=?0.70, 95%CI 0.53-0.91), compared to patients without tool use. The ETOT analyses also showed higher rates of receipt of return visits, well-child visits, and several immunizations among patients for whom the tools were used. CONCLUSIONS:This pragmatic trial, the first to evaluate EHR-based insurance assistance tools, suggests that it is feasible to create and implement tools that help clinics provide insurance enrollment support to pediatric patients. While ITT findings were limited by low rates of tool use, ITT and ETOT findings suggest tool use was associated with better odds of gaining and keeping coverage. Further, ETOT findings suggest that use of such tools may positively impact healthcare utilization and quality of pediatric care. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02298361 ; retrospectively registered on November 5, 2014.

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Dataset Information

How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.

Objectives

Design, setting and participants

Results

Conclusions

Publications

How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.

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