scholarly journals Methods to Describe Referral Patterns in a Canadian Primary Care Electronic Medical Record Database: Modelling Multilevel Count Data

2017 ◽  
Vol 24 (4) ◽  
pp. 311 ◽  
Author(s):  
Bridget L Ryan ◽  
Joshua Shadd ◽  
Heather Maddocks ◽  
Moira Stewart ◽  
Amardeep Thind ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Count Data ◽  
Chronic Conditions ◽  
Rural Practice ◽  
Patient Journey ◽  
Referral Patterns ◽  
Referral Rates ◽  
Multi Level

Background:  A referral from a family physician (FP) to a specialist is an inflection point in the patient journey, with potential implications for clinical outcomes and health policy. Primary care electronic medical record (EMR) databases offer opportunities to examine referral patterns. Until recently, software techniques were not available to model these kinds of multi-level count data. Objective:  To establish methodology for determining referral rates from FPs to medical specialists using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) EMR database. Method: Retrospective cohort study, mixed effects and multi-level negative binomial regression modelling with 87,258 eligible patients between 2007 and 2012. Mean referrals compared by patient sex, age, chronic conditions, FP visits, and urban/rural practice location.  Proportion of variance in referral rates attributable to the patient and practice levels. Results:  On average, males had 0.26, and females 0.31 referrals in a 12-month period.  Referrals were significantly higher for females, increased with age, FP visits, and number of chronic conditions (p<.0001). Overall, 14% of the variance in referrals could be attributed to the practice level, and 86% to patient level characteristics. Conclusions:  Both patient and practice characteristics influenced referral patterns. The methodologic insights gained from this study have relevance to future studies on many research questions that utilize count data, both within primary care and broader health services research. The utility of the CPCSSN database will continue to increase in tandem with data quality improvements, providing a valuable resource to study Canadian referral patterns over time.

scholarly journals Electronic medical record use in pediatric primary care

2011 ◽  
Vol 18 (1) ◽  
pp. 38-44 ◽  
Author(s):  
Alexander G Fiks ◽  
Evaline A Alessandrini ◽  
Christopher B Forrest ◽  
Saira Khan ◽  
A Russell Localio ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Pediatric Primary Care

Use of the Electronic Medical Record to Facilitate Intervention for Patients With Rising Prostate-Specific Antigen Values After Radical Prostatectomy: A Feasibility Study

2017 ◽  
pp. 1-6
Author(s):  
Amar U. Kishan ◽  
Eric M. Cheng ◽  
Eric Schmidt ◽  
Christopher Saigal ◽  
Robert E. Reiter ◽  
...  
Keyword(s):  
Medical Record ◽  
Prostate Specific Antigen ◽  
Electronic Medical Record ◽  
Specific Antigen ◽  
Standard Of Care ◽  
Oncologic Outcomes ◽  
Tumor Board ◽  
Direct Function ◽  
Support Tool ◽  
Referral Rates

Purpose Salvage radiotherapy (SRT) is the standard of care offered when postprostatectomy prostate-specific antigen (PSA) levels are ≥ 0.2 ng/mL. However, emerging evidence suggests that early SRT (ie, SRT delivered at PSA values < 0.2 ng/mL, but generally ≥ 0.05 ng/mL) improves oncologic outcomes. We evaluated the feasibility of improving referral rates for discussion of early SRT by using a dynamic registry that identifies through the electronic medical record patients with rising postprostatectomy PSA levels. Methods We developed an iteratively updated registry that identifies patients who fall within two postoperative PSA strata: ≥ 0.05 to < 0.1 ng/mL and ≥ 0.1 to < 0.2 ng/mL. We compared referral rates to radiation oncology during a 3-year period before use of this registry with those during a 1-year period after promotion of the registry in multidisciplinary tumor board settings. Results Before promotion of the registry, referral rates for patients with PSA values ≥ 0.05 to < 0.1 ng/mL and ≥ 0.1 to < 0.2 ng/mL were 35% and 65%, respectively. After promotion of the registry, referral rates within each stratum increased significantly to 82% and 94%, respectively ( P < .05 for both by Fisher’s exact test). The overall rate of referral for patients with PSA values ≥ 0.05 to < 0.2 ng/mL rose from 48% to 90% ( P < .001). Conclusion The creation of a registry of patients with rising postprostatectomy PSA values can facilitate increased referral rates for early SRT without burdening providers with a clinical support tool embedded within the EMR itself. This is true even in the case of already high baseline rates of referral for early SRT. The changes reported herein most likely reflect a Hawthorne effect wherein the ability to track referrals rather than a direct function of the registry influenced practice patterns. Nonetheless, the registry provided an integral framework to allow for tracking.

scholarly journals Adoption of an Electronic Medical Record Tool for Childhood Obesity by Primary Care Providers

2020 ◽  
Vol 11 (02) ◽  
pp. 210-217
Author(s):  
Amy Williams ◽  
Christy Turer ◽  
Jamie Smith ◽  
Isabelle Nievera ◽  
Laura McCulloch ◽  
...  
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Primary Care Providers ◽  
Perceived Usefulness ◽  
Intention To Use ◽  
Care Providers ◽  
Perceived Usability ◽  
Strongly Agree

Abstract Background Primary care providers are tasked with the increasingly difficult job of addressing childhood obesity during clinic visits. Electronic medical record (EMR)-enabled decision-support tools may aid providers in this task; however, information is needed regarding whether providers perceive such tools to be useful for addressing nutrition and physical activity lifestyle behaviors. Objectives This study aimed to evaluate the usefulness and usability of FitTastic, an EMR-enabled tool to support prevention and management of childhood obesity in primary care. Methods In this mixed-method study, we implemented the FitTastic tool in two primary-care clinics, then surveyed and conducted focused interviews with providers. Validated Technology Acceptance Model perceived usefulness and National Aeronautics and Space Administration (NASA) perceived usability survey questions were e-mailed to 60 providers. In-depth provider interviews with family medicine and pediatric physicians (n = 12) were used to further probe adoption of FitTastic. Results Surveys were completed by 73% of providers (n = 44). The mean score for FitTastic's usefulness was 3.3 (standard deviation [SD] = 0.54, scale 1–5, where 5 is strongly agree) and usability, 4.8 (SD = 0.86, scale 1–7, where 7 is strongly agree). Usefulness and usability scores were associated with intention to use FitTastic (correlation for both, p < 0.05). Data from provider interviews indicated that useful features of FitTastic included: standardizing the approach to childhood obesity, and facilitating conversations about weight management, without increasing cognitive workload. However, use of FitTastic required more time from nurses to input lifestyle data. Conclusion FitTastic is perceived as a useful and usable EMR-based lifestyle behavior tool that standardizes, facilitates, and streamlines healthy lifestyle conversations with families. Perceived usability and usefulness scores correlated with provider intention-to-use the technology. These data suggest that EMR-based child obesity prevention and management tools can be feasible to use in the clinic setting, with potential for scalability. Usefulness can be optimized by limiting amount of time needed by staff to input data.

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