Appl Clin Inform 2010; 01(03): 318-330
DOI: 10.4338/ACI-2010-04-RA-0022
Research Article
Schattauer GmbH

Perceived Frequency and Impact of Missing Information at Pediatric Emergency and General Ambulatory Encounters

Lisa M. Schilling
1   University of Colorado Denver School of Medicine, Department of Medicine
,
Lori A. Crane
2   University of Colorado Denver School of Public Health, Department of Preventive Medicine and Biometrics
,
Allison Kempe
3   Department of Pediatrics, University of Colorado Denver School of Medicine, and the Children‘s Outcomes Research Program, The Children‘s Hospital
,
Deborah S. Main
4   Department of Family Medicine, University of Colorado Denver School of Medicine and the Colorado Health Outcomes Program
,
Marion R. Sills
5   Department of Pediatrics, Department of Preventive Medicine and Biometrics, University of Colorado Denver School of Medicine, The Children’s Hospital
,
Arthur J. Davidson
6   Denver Public Health, Denver Health and the University of Colorado Denver School of Medicine
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Correspondence to:

Lisa Schilling, MD, MSPH
Campus Box B180,
UCDHSC, Academic Office 1, PO Box 6511
Aurora, CO 80045
Telefon: 303-724-2254   
Fax: 303-724-2270   

Publikationsverlauf

received: 21. April 2010

accepted: 05. August 2010

Publikationsdatum:
16. Dezember 2017 (online)

 

Summary

Objective: To document the perceived frequency, type, and impact of unavailable (“missing”) clinical information during pediatric emergency and general ambulatory encounters.

Methods: This prospective cohort set in the Emergency Department and General Ambulatory Pediatric Clinic at The Children’s Hospital, Aurora, CO, assessed pediatric attending physician perceptions regarding missing information at emergency and general ambulatory encounters. The main outcome measures were the frequency of perceived missing information; its presumed location; time spent seeking; and the perceived effects on resource utilization and overall quality of care.

Results: Pediatric physicians reported missing information for 2% of emergency and 22% of general ambulatory encounters. Types of missing information at general ambulatory visits included immunization (34% of types), general past medical (29%), and disease or visit specific histories (13%). Missing information at ambulatory visits was sought 20% of the time, obtained 4% of the time, and rated “somewhat or very important for today’s care” (73% of the time) and “somewhat or very important for future care” (84% of the time). For encounters with unattained missing information, physicians reported adverse affects on the efficiency of the visit (64%), physician’s confidence in care (33%), patient/family satisfaction (17%), disposition decisions (8%), and recommended additional treatment (38%), laboratory studies (16%), and imaging (12%). For 57% of encounters with missing information, physicians perceived an adverse effect on overall quality of care. Missing information was associated with not having a primary care visit at TCH within 12 months of the encounter, (OR 2.8; 95% CI, 1.7, 4.5).

Conclusion: Pediatric physicians more commonly experience missing information at general ambulatory visits than emergency visits and report that missing information adversely impacts quality, efficiency, their confidence in care, patient and family satisfaction, and leads to potentially redundant resource utilization.


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  • References

  • 1 Blendon RJ. et al. Common concerns amid diverse systems: health care experiences in five countries. Health Aff (Millwood) 2003; 22 (03) 106-121.
  • 2 Schoen C. et al. Primary care and health system performance: adults’ experiences in five countries. Health Aff (Millwood). 2004; W4 Suppl. Web Exclusives 487-503.
  • 3 Smith PC. et al. Missing clinical information during primary care visits. JAMA 2005; 293 (05) 565-571.
  • 4 Elder NC, Vonder Meulen M, Cassedy A. The identification of medical errors by family physicians during outpatient visits. Ann Fam Med 2004; 2 (02) 125-129.
  • 5 Forster AJ. et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 2003; 138 (03) 161-167.
  • 6 Stiell A. et al. Prevalence of information gaps in the emergency department and the effect on patient outcomes. CMAJ 2003; 169 (010) 1023-1028.
  • 7 The Colorado Immunization Information System. http://www.cdphe.state.co.us/dc/immunization/ciis . Accessed June 22, 2010.
  • 8 Centers for Disesae Control Vital and Health Statistics. Advanced Data 2006: 374. http://www.cdc.gov/nchs/data/ad/ad374.pdf . Accessed June 22, 2010.
  • 9 Walker J. et al. The value of health care information exchange and interoperability. Health Aff (Millwood). 2005; W5 (Suppl Web Exclusives).
  • 10 Kibbe DC, Phillips Jr RL, Green LA. The continuity of care record. Am Fam Physician. 2004; 70 (07) 1220 1222-1223.
  • 11 eHealth Initiative.. Sixth Annual Survey of Health Information Exchange –Migrating Toward Meaningful Use: The State of Health Information Exchange. 2009 http://www.ehealthinitiative.org/sites/default/files/file/2009%20Survey%20Report%20FINAL.pdf. Accessed June 22, 2010.
  • 12 Joseph CL. et al. Visiting multiple sites for immunization and vaccine coverage levels of preschool children in 3 urban clinics: potential indicator of record scatter?. Clin Pediatr (Phila) 2002; 41 (04) 249-256.
  • 13 Santoli JM, Szilagyi PG, Rodewald LE. Barriers to immunization and missed opportunities. Pediatr Ann 1998; 27 (06) 366-374.
  • 14 Stokley S, Rodewald LE, Maes EF. The impact of record scattering on the measurement of immunization coverage. Pediatrics 2001; 107 (01) 91-96.
  • 15 Kempe A. et al. How much does a regional immunization registry increase documented immunization rates at primary care sites in rural colorado?. Ambul Pediatr 2001; 1 (04) 213-216.
  • 16 Renfrew BL. et al. The impact of immunization record aggregation on up-to-date rates –implications for immunization registries in rural areas. J Rural Health 2001; 17 (02) 122-126.
  • 17 Yawn BP. et al. The impact of a simulated immunization registry on perceived childhood immunization status. Am J Manag Care 1998; 4 (02) 185-192.
  • 18 Finnell JT. et al. Community clinical data exchange for emergency medicine patients. AMIA Annu Symp Proc 2003: 235-238.
  • 19 National Medicare Facility Total RVU Value for the Current Procedural Terminology (CPT) Codes. 4th ed 2006.
  • 20 Poon EG. et al. “I wish I had seen this test result earlier!”: Dissatisfaction with test result management systems in primary care. Arch Intern Med 2004; 164 (020) 2223-2228.
  • 21 Wilson RM. et al. An analysis of the causes of adverse events from the Quality in Australian Health Care Study. Med J Aust 1999; 170 (09) 411-415.
  • 22 Gilchrist VJ. et al. A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits. Med Care 2004; 42 (03) 276-280.

Correspondence to:

Lisa Schilling, MD, MSPH
Campus Box B180,
UCDHSC, Academic Office 1, PO Box 6511
Aurora, CO 80045
Telefon: 303-724-2254   
Fax: 303-724-2270   

  • References

  • 1 Blendon RJ. et al. Common concerns amid diverse systems: health care experiences in five countries. Health Aff (Millwood) 2003; 22 (03) 106-121.
  • 2 Schoen C. et al. Primary care and health system performance: adults’ experiences in five countries. Health Aff (Millwood). 2004; W4 Suppl. Web Exclusives 487-503.
  • 3 Smith PC. et al. Missing clinical information during primary care visits. JAMA 2005; 293 (05) 565-571.
  • 4 Elder NC, Vonder Meulen M, Cassedy A. The identification of medical errors by family physicians during outpatient visits. Ann Fam Med 2004; 2 (02) 125-129.
  • 5 Forster AJ. et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 2003; 138 (03) 161-167.
  • 6 Stiell A. et al. Prevalence of information gaps in the emergency department and the effect on patient outcomes. CMAJ 2003; 169 (010) 1023-1028.
  • 7 The Colorado Immunization Information System. http://www.cdphe.state.co.us/dc/immunization/ciis . Accessed June 22, 2010.
  • 8 Centers for Disesae Control Vital and Health Statistics. Advanced Data 2006: 374. http://www.cdc.gov/nchs/data/ad/ad374.pdf . Accessed June 22, 2010.
  • 9 Walker J. et al. The value of health care information exchange and interoperability. Health Aff (Millwood). 2005; W5 (Suppl Web Exclusives).
  • 10 Kibbe DC, Phillips Jr RL, Green LA. The continuity of care record. Am Fam Physician. 2004; 70 (07) 1220 1222-1223.
  • 11 eHealth Initiative.. Sixth Annual Survey of Health Information Exchange –Migrating Toward Meaningful Use: The State of Health Information Exchange. 2009 http://www.ehealthinitiative.org/sites/default/files/file/2009%20Survey%20Report%20FINAL.pdf. Accessed June 22, 2010.
  • 12 Joseph CL. et al. Visiting multiple sites for immunization and vaccine coverage levels of preschool children in 3 urban clinics: potential indicator of record scatter?. Clin Pediatr (Phila) 2002; 41 (04) 249-256.
  • 13 Santoli JM, Szilagyi PG, Rodewald LE. Barriers to immunization and missed opportunities. Pediatr Ann 1998; 27 (06) 366-374.
  • 14 Stokley S, Rodewald LE, Maes EF. The impact of record scattering on the measurement of immunization coverage. Pediatrics 2001; 107 (01) 91-96.
  • 15 Kempe A. et al. How much does a regional immunization registry increase documented immunization rates at primary care sites in rural colorado?. Ambul Pediatr 2001; 1 (04) 213-216.
  • 16 Renfrew BL. et al. The impact of immunization record aggregation on up-to-date rates –implications for immunization registries in rural areas. J Rural Health 2001; 17 (02) 122-126.
  • 17 Yawn BP. et al. The impact of a simulated immunization registry on perceived childhood immunization status. Am J Manag Care 1998; 4 (02) 185-192.
  • 18 Finnell JT. et al. Community clinical data exchange for emergency medicine patients. AMIA Annu Symp Proc 2003: 235-238.
  • 19 National Medicare Facility Total RVU Value for the Current Procedural Terminology (CPT) Codes. 4th ed 2006.
  • 20 Poon EG. et al. “I wish I had seen this test result earlier!”: Dissatisfaction with test result management systems in primary care. Arch Intern Med 2004; 164 (020) 2223-2228.
  • 21 Wilson RM. et al. An analysis of the causes of adverse events from the Quality in Australian Health Care Study. Med J Aust 1999; 170 (09) 411-415.
  • 22 Gilchrist VJ. et al. A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits. Med Care 2004; 42 (03) 276-280.