制定基于电子健康记录的4M措施,以支持对年龄友好型卫生系统的实施和证据生成
Robert L Thombley1,2, Stephanie E Rogers3, Julia Adler-Milstein1,2
1Department of Medicine, Division of Clinical Informatics and Digital Transformation, University of California, San Francisco, California, USA.
Journal of the American Geriatrics Society
|December 21, 2023
概括
开发电子健康记录 (EHR) 措施,用于4M框架 (重要的是什么,药物,思维,流动性) 是可行的. 这些措施为改善医疗保健环境中的4M实施提供了洞察力.
科学领域:
- 老年医学 老年医学
- 医疗信息学 医疗信息学
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 卫生保健改进研究所 (IHI) 4Ms框架旨在改善对老年人的护理.
- 将IHI推的4M日常护理实践转化为可衡量的指标对于评估影响至关重要.
- 电子健康记录 (EHR) 为创建这些遵守措施提供了一个潜在的数据源.
研究的目的:
- 为4M框架制定和实施基于EHR的遭遇级合规措施.
- 评估使用结构化EHR数据来量化4M护理实践的可行性.
- 在一个学术医疗中心生成指导正在进行的4M实施工作的数据.
主要方法:
- 通过使用结构化EHR数据,将19个IHI 4M护理实践转化为接触层面的遵守措施.
- 开发了针对整体4M合规性和个别"M"组件的综合措施.
- 使用Epic EHR数据对19,335名65岁以上的患者进行了操作化测量,这些患者在2019-2021年期间入院于UCSF健康.
主要成果:
- 开发了18项基于EHR的措施,其中16项使用UCSF健康EHR数据实施.
- 在"处方高风险药物"措施中实现了29.5%的遵守率.
- 对于4M复合指标的平均遭遇依从率为61.1% (SD=14.4%),其中对"重要的是什么"的依从率最低 (50.9%),对"引用"的依从率最高 (68.4%).
结论:
- 可以使用EHR数据可行地构建相遇级别的4M遵守措施.
- 这些措施为指导和完善4M实施战略提供了有价值的见解.
- 未来的工作应该集中在验证这些开发的措施的可靠性和准确性.
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