Abstract

Objective

To evaluate the effect of electronic health record (EHR)-integrated digital health tools comprised of a checklist and video on transitions-of-care outcomes for patients preparing for discharge.

Materials and Methods

English-speaking, general medicine patients (>18 years) hospitalized at least 24 hours at an academic medical center in Boston, MA were enrolled before and after implementation. A structured checklist and video were administered on a mobile device via a patient portal or web-based survey at least 24 hours prior to anticipated discharge. Checklist responses were available for clinicians to review in real time via an EHR-integrated safety dashboard. The primary outcome was patient activation at discharge assessed by patient activation (PAM)-13. Secondary outcomes included postdischarge patient activation, hospital operational metrics, healthcare resource utilization assessed by 30-day follow-up calls and administrative data and change in patient activation from discharge to 30 days postdischarge.

Results

Of 673 patients approached, 484 (71.9%) enrolled. The proportion of activated patients (PAM level 3 or 4) at discharge was nonsignificantly higher for the 234 postimplementation compared with the 245 preimplementation participants (59.8% vs 56.7%, adjusted OR 1.23 [0.38, 3.96], P = .73). Postimplementation participants reported 3.75 (3.02) concerns via the checklist. Mean length of stay was significantly higher for postimplementation compared with preimplementation participants (10.13 vs 6.21, P < .01). While there was no effect on postdischarge outcomes, there was a nonsignificant decrease in change in patient activation within participants from pre- to postimplementation (adjusted difference-in-difference of −16.1% (9.6), P = .09).

Conclusions

EHR-integrated digital health tools to prepare patients for discharge did not significantly increase patient activation and was associated with a longer length of stay. While issues uncovered by the checklist may have encouraged patients to inquire about their discharge preparedness, other factors associated with patient activation and length of stay may explain our observations. We offer insights for using PAM-13 in context of real-world health-IT implementations.

Trial Registration

NIH US National Library of Medicine, NCT03116074, clinicaltrials.gov

中文翻译：

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评估电子健康记录集成的数字健康工具以使住院患者参与出院准备

摘要

客观的

评估电子健康记录 (EHR) 集成的数字健康工具对准备出院的患者的护理过渡结果的影响，该工具由清单和视频组成。

材料和方法

在实施前后在马萨诸塞州波士顿的一个学术医疗中心住院至少 24 小时的讲英语的普通内科患者（>18 岁）被纳入研究。在预计出院前至少 24 小时，通过患者门户网站或基于网络的调查在移动设备上管理结构化检查表和视频。临床医生可以通过 EHR 集成的安全仪表板实时查看清单响应。主要结果是出院时通过患者激活 (PAM)-13 评估的患者激活。次要结果包括出院后患者的激活、医院运营指标、通过 30 天的随访电话和管理数据评估的医疗资源利用率，以及从出院到出院后 30 天患者激活的变化。

结果

在 673 名患者中，484 名（71.9%）入组。与 245 名实施前参与者相比，实施后 234 名患者出院时激活患者（PAM 水平 3 或 4）的比例没有显着增加（59.8% 对 56.7%，调整后的 OR 1.23 [0.38, 3.96]，P  = .73）。实施后参与者通过清单报告了 3.75 (3.02) 个问题。与实施前参与者相比，实施后参与者的平均住院时间明显更长（10.13 vs 6.21，P  < .01）。虽然对出院后结果没有影响，但从实施前到实施后，参与者的患者激活变化没有显着降低（调整后的差异为 -16.1% (9.6)，P  = .09）。

结论

为患者出院做准备的 EHR 集成数字健康工具并未显着增加患者的活跃度，并且与更长的住院时间相关。虽然清单中发现的问题可能鼓励患者询问他们的出院准备情况，但与患者激活和住院时间相关的其他因素可以解释我们的观察结果。我们提供了在实际健康 IT 实施环境中使用 PAM-13 的见解。

试用注册

NIH 美国国家医学图书馆，NCT03116074，clinicaltrials.gov