Team-Based Health Information Exchange Use Increased Mammography Documentation and Referral in an Academic Primary Care Practice: An Interrupted Time Series.
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ABSTRACT:
SUBMITTER: Pitts SI
PROVIDER: S-EPMC5910338 | biostudies-literature | 2018 May
REPOSITORIES: biostudies-literature
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Team-Based Health Information Exchange Use Increased Mammography Documentation and Referral in an Academic Primary Care Practice: An Interrupted Time Series.
Pitts Samantha I SI Maruthur Nisa M NM Wang Xiao X Sawyer Melinda D MD Grimes Renee R Nigrin Candace C Clark Jeanne M JM Wang Nae-Yuh NY Sateia Heather F HF Peairs Kimberly S KS
Journal of general internal medicine 20180201 5
<h4>Background</h4>Few studies have examined the impact of health information exchanges (HIE) on quality in ambulatory settings.<h4>Methods</h4>From September 29, 2014, to September 4, 2015, we conducted an interrupted time series analysis of query-based use of the state HIE as part of team-based care to improve mammography screening in an academic primary care practice. Women aged 50-74 years with a practice visit and who were eligible for mammography were included. We conducted non-parametric ...[more]
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Project description:IntroductionInterrupted Time Series (ITS) studies may be used to assess the impact of an interruption, such as an intervention or exposure. The data from such studies are particularly amenable to visual display and, when clearly depicted, can readily show the short- and long-term impact of an interruption. Further, well-constructed graphs allow data to be extracted using digitizing software, which can facilitate their inclusion in systematic reviews and meta-analyses.AimWe provide recommendations for graphing ITS data, examine the properties of plots presented in ITS studies, and provide examples employing our recommendations.Methods and resultsGraphing recommendations from seminal data visualization resources were adapted for use with ITS studies. The adapted recommendations cover plotting of data points, trend lines, interruptions, additional lines and general graph components. We assessed whether 217 graphs from recently published (2013-2017) ITS studies met our recommendations and found that 130 graphs (60%) had clearly distinct data points, 100 (46%) had trend lines, and 161 (74%) had a clearly defined interruption. Accurate data extraction (requiring distinct points that align with axis tick marks and labels that allow the points to be interpreted) was possible in only 72 (33%) graphs.ConclusionWe found that many ITS graphs did not meet our recommendations and could be improved with simple changes. Our proposed recommendations aim to achieve greater standardization and improvement in the display of ITS data, and facilitate re-use of the data in systematic reviews and meta-analyses.
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Project description:BackgroundWith the aging society, the number of emergency transportations has been growing. Although it is important that a patient be immediately transported to an appropriate hospital for proper management, accurate diagnosis in the prehospital setting is challenging. However, at present, patient information is mainly communicated by telephone, which has a potential risk of communication errors such as mishearing. Sharing correct and detailed prehospital information with emergency departments (EDs) should facilitate optimal patient care and resource use. Therefore, the implementation of an app that provides on-site, real-time information to emergency physicians could be useful for early preparation, intervention, and effective use of medical and human resources.ObjectiveIn this paper, we aimed to examine whether the implementation of a mobile app for emergency medical service (EMS) would improve patient outcomes and reduce transportation time as well as communication time by phone (ie, phone-communication time).MethodsWe performed an interrupted time-series analysis (ITSA) on the data from a tertiary care hospital in Japan from July 2021 to October 2021 (8 weeks before and 8 weeks after the implementation period). We included all patients transported by EMS. Using the mobile app, EMS can send information on patient demographics, vital signs, medications, and photos of the scene to the ED. The outcome measure was inpatient mortality and transportation time, as well as phone-communication time, which was the time for EMS to negotiate with ED staffs for transport requests.ResultsDuring the study period, 1966 emergency transportations were made (n=1033, 53% patients during the preimplementation period and n=933, 47% patients after the implementation period). The ITSA did not reveal a significant decrease in patient mortality and transportation time before and after the implementation. However, the ITSA revealed a significant decrease in mean phone-communication time between pre- and postimplementation periods (from 216 to 171 seconds; -45 seconds; 95% CI -71 to -18 seconds). From the pre- to postimplementation period, the mean transportation time from EMS request to ED arrival decreased by 0.29 minutes (from 36.1 minutes to 35.9 minutes; 95% CI -2.20 to 1.60 minutes), without change in time trends. We also introduced cases where the app allowed EMS to share accurate and detailed prehospital information with the emergency department, resulting in timely intervention and reducing the burden on the ED.ConclusionsThe implementation of a mobile app for EMS was associated with reduced phone-communication time by 45 seconds (22%) without increasing mortality or overall transportation time despite the implementation of new methods in the real clinical setting. In addition, real-time patient information sharing, such as the transfer of monitor images and photos of the accident site, could facilitate optimal patient care and resource use.
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