PubMed · 15449885
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
David S Pisetsky. 2004. OutOfDate.. https://pubmed.ncbi.nlm.nih.gov/15449885/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
OBJECTIVE: To determine the effectiveness of Internet-based audit and feedback to physicians to improve care for diabetes and hypertension. DESIGN: Time-series analysis of an intervention. METHODS: The study setting was Harvard Vanguard Medical Associates, a 14-site multispecialty group in greater Boston. The study period was July 1997-June 1999. PARTICIPANTS: were 12 primary care internal medicine residents who provided care to adult patients with diabetes (n = 76 pre-intervention and n = 88 post-intervention), hypertension (n = 329 pre-intervention and n = 338 post-intervention), or both (n = 62 pre-intervention and n = 71 post-intervention). We determined the proportion of each resident's patients whose care fulfilled national guidelines for quality (i.e. diabetes patients had hemoglobin testing in the previous 6 months or hypertension patients received a beta-blocker or diuretic in the same time period). After meeting individually with each resident to obtain informed consent and to encourage participation, we sent each resident information for accessing his or her practice profile on a secure website. The main outcome measures were (i) the proportion of resident physicians who accessed their profiles and (ii) change following the intervention in the proportion of patients whose care followed national guidelines. RESULTS: Over a 1-year period, only four of the 12 residents accessed their websites. One of the residents visited her site three times, while the other three residents visited their sites once each. In interrupted time-series analyses, the intervention had no discernible effect on adherence to practice guidelines for diabetes or hypertension. CONCLUSION: The lack of participation in this Internet-based intervention may have important implications for the development of future programs that require physicians to interact with technology to improve quality of care.
OBJECTIVE: To investigate the impact of a computer-based documentation (CBD) tool on parent and physician satisfaction with a pediatric health maintenance encounter. DESIGN: The project used a preintervention and postintervention design. The preintervention group visits used paper-based forms for data entry, whereas the postintervention visits used CBD. At the conclusion of each encounter, both the physician and the parent completed a survey that assessed their perceptions of the encounter's quality. SETTING: Urban hospital-based pediatric teaching clinic. PARTICIPANTS: Parents and physicians of children 18 months and younger. MAIN OUTCOME MEASURES: Parent and physician satisfaction with 7 components of a health maintenance encounter (interim history, social history, anticipatory guidance, developmental assessment, physical examination, assessment, and plan). RESULTS: There was no change in overall parent or physician satisfaction in the areas of communication or physician helpfulness. Physicians using CBD were less likely to agree that they provided clear explanations but were also less likely to agree that they "acted bossy during the visit." There was no correlation between physician and parent satisfaction or between physician satisfaction and pattern of CBD use. However, there was a strong correlation between physicians' satisfaction and the extent to which they found CBD helpful (Spearman rho = 0.29, P<.001). CONCLUSIONS: The introduction of CBD into the health maintenance encounter did not affect measured aspects of parent or physician satisfaction; these results support its continued use in that setting.
The adoption of electronic medical records (EMRs) and user satisfaction are closely associated with the system's usability. To improve the usability of a results management module of a widely deployed web-based EMR, we conducted two qualitative studies that included multiple focus group and field study sessions. Qualitative research can help focus attention on user tasks and goals and identify patterns of care that can be visualized through task modeling exercises. Findings from both studies raised issues with the amount and organization of information in the display, interference with workflow patterns of primary care physicians, and the availability of visual cues and feedback. We used the findings of these studies to recommend design changes to the user interface of the results management module.