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A comparison of problem lists generated by physicians, nurses, and patients: implications for CPR systems
1School of Nursing, University of California, San Francisco, USA.
Insights
Physician, nurse, and patient problem lists for Pneumocystis pneumonia patients show overlap in medical issues but unique insights in nursing and patient-generated lists, highlighting the need for a unified approach.
Area of Science:
- Medical Informatics
- Nursing Research
- Patient-Reported Outcomes
Background:
- Problem lists are crucial for patient care documentation.
- Discrepancies in problem lists can lead to fragmented care.
- Understanding the overlap and unique contributions of different sources is vital.
Purpose of the Study:
- To compare problem lists generated by physicians, nurses, and patients for Pneumocystis carinii pneumonia (PCP) patients.
- To identify areas of overlap and unique problems within each list.
- To advocate for a unified problem list for improved patient care and electronic health records.
Main Methods:
- Analysis of problem lists from 201 hospitalized PCP patients.
- Comparison of physician-generated lists with nurse- and patient-generated lists.
- Identification of common and unique problems across all three sources.
Main Results:
- Significant overlap exists for problems related to the primary medical diagnosis and symptoms.
- Nurse lists uniquely identified knowledge deficits and potential for injury.
- Patient lists revealed psychosocial problems not captured by clinicians (34%).
Conclusions:
- Nurse and patient problem lists offer critical, unique data impacting patient status and outcomes.
- A unified, multidisciplinary problem list is essential for comprehensive patient views.
- Development of data models and controlled vocabularies is needed for integrated electronic patient record systems.
Abstract:
Using a sample of 201 patients hospitalized for Pneumocystis carinii pneumonia, this study describes problem lists generated by physicians and examines the overlap among problem lists generated by physicians, nurses, and patients. The findings indicate that the majority of patients in this sample had at least one problem that occurred in more than one problem list. Problems that most frequently appeared in more than one problem list were those related to the medical diagnosis of Pneumocystis carinii pneumonia and its associated physiological symptoms. Problems which occurred uniquely in the nurse problem list were knowledge deficit and potential for injury. Thirty-four percent of the patients identified at least one psychosocial problem that did not occur in either the physician- or nurse-generated problem lists. The study findings demonstrate that while there is overlap among the problem lists in problems related to the principal medical diagnoses, the nurse- and patient-generated problem lists include unique problems which provide additional significant information related to patient status that has the potential to impact patient outcomes. These findings suggest that a unified, nonredundant, multidisciplinary problem list is warranted in order to provide a comprehensive view of the patient for computer-based patient record (CPR) systems. Appropriate data models and comprehensive controlled vocabularies are needed to support the multiple uses of the problem list for CPR systems.