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目的医疗保健管理者鼓励临床医生为患者提供能进入个人健康档案的门户,但实施起来还存有挑战性。尽管大型综合卫生系统一直以来通过昂贵的广告活动推广使用,但对于中小型诊所还需寻找其他可行方法。方法采用混合评估法,评价了8个初级保健诊所提出患者门户(即患者信息门户信息系统)的实施策略〔互动预防性健康档案(IPHR)〕。与实施优胜者进行了一系列的学习合作,且重新设计工作流程以实现医疗门户一体化。对诊所实施策略、患者信息门户的利用及影响因素进行了前瞻性评估。结果由诊所制定的实施策略促使25.6%的患者使用了IPHR,31个月,每月增长率为1.0%。有23.5%的患者就诊当日就签名使用了IPHR。老年及有并存病患者使用IPHR多,黑人和西班牙人使用较少。为了提升利用率,基于临床医生的特性以及诊所采纳改革后的工作流程,诊所实施情况大不相同(从使用率22.1%升高至27.9%,P<0.001)。结论通过促进患者使用信息门户,帮助诊所实现医疗一体化,那么初级保健诊所完全能够达到、甚至超过大型卫生系统的使用率。
Objectives Health care managers encourage clinicians to provide patients with access to personal health records, but implementation can be challenging. Although large-scale integrated health systems have long been promoted through costly advertising campaigns, other options for small and medium-sized clinics need to be sought. Methods A mixed assessment method was used to evaluate the implementation strategy (IPHR) of the eight primary care clinics that proposed a patient portal (ie, patient information portal information system). A series of learning collaborations with the implementing winners and the redesign of the workflow to achieve medical portal integration. Prospective assessment of the implementation of clinics, the use of patient information portals and their influencing factors. Results The implementation strategy developed by the clinic led to the use of IPHR in 25.6% of patients, a 31-month increase of 1.0% per month. 23.5% of patients signed on the day of their visit used IPHR. Older and co-morbid patients use more IPHR, blacks and Hispanics use less. To improve utilization, clinics performed significantly differently (from 22.1% utilization rate to 27.9%, P <0.001) based on the clinician’s characteristics and the adoption of the reformed workflow at the clinic. Conclusion By facilitating the use of information portals and helping clinics achieve healthcare integration, primary care clinics are fully capable of meeting or even exceeding the utilization rates of major health systems.