 |
|
Missing Clinical Information During Primary Care Visits
Peter C. Smith, MD;
Rodrigo Araya-Guerra, BA;
Caroline Bublitz, MS;
Bennett Parnes, MD;
L. Miriam Dickinson, PhD;
Rebecca Van Vorst, BA;
John M. Westfall, MD, MPH;
Wilson D. Pace, MD
JAMA. 2005;293:565-571.
Context The coordinating function of primary care is information-intensive and may be impeded by missing clinical information. However, missing clinical information has not been explicitly investigated in the primary care setting.
Objective To describe primary care clinicians’ reports of missing clinical information.
Design, Setting, and Participants Cross-sectional survey conducted in 32 primary care clinics within State Networks of Colorado Ambulatory Practices and Partners (SNOCAP), a consortium of practice-based research networks participating in the Applied Strategies for Improving Patient Safety medical error reporting study. Two hundred fifty-three clinicians were surveyed about 1614 patient visits between May and December 2003. For every visit during 1 half-day session, each clinician completed a questionnaire about patient and visit characteristics and stated whether important clinical information had been missing. Clinician characteristics were also recorded.
Main Outcome Measures Reports of missing clinical information frequency, type, and presumed location; perceived likelihood of adverse effects, delays in care, and additional services; and time spent looking for missing information. Multivariate analysis was conducted to assess the relationship of missing information to patient, visit, or clinician characteristics, adjusting for potential confounders and effects of clustering.
Results Clinicians reported missing clinical information in 13.6% of visits; missing information included laboratory results (6.1% of all visits), letters/dictation (5.4%), radiology results (3.8%), history and physical examination (3.7%), and medications (3.2%). Missing clinical information was frequently reported to be located outside their clinical system but within the United States (52.3%), to be at least somewhat likely to adversely affect patients (44%), and to potentially result in delayed care or additional services (59.5%). Significant time was reportedly spent unsuccessfully searching for missing clinical information (5-10 minutes, 25.6%; >10 minutes, 10.4%). After adjustment, reported missing clinical information was more likely when patients were recent immigrants (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.06-2.99), new patients (OR, 2.39; 95% CI, 1.70-3.35), or had multiple medical problems compared with no problems (1 problem: OR, 1.09; 95% CI, 0.69-1.73; 2-5 problems: OR, 1.87; 95% CI, 1.21-2.89; >5 problems: OR, 2.78; 95% CI, 1.61-4.80). Missing clinical information was less likely in rural practices (OR, 0.52; 95% CI, 0.29-0.92) and when individual clinicians reported having full electronic records (OR, 0.40; 95% CI, 0.17-0.94).
Conclusions Primary care clinicians report that missing clinical information is common, multifaceted, likely to consume time and other resources, and may adversely affect patients. Additional research on missing information is needed to focus on validating clinicians’ perceptions and on conducting prospective studies of its causes and sequelae.
Author Affiliations: Department of Family Medicine, University of Colorado Health Sciences Center, Denver.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
RELATED ARTICLE
Missing Clinical Information: The System Is Down
Nancy C. Elder and John Hickner
JAMA. 2005;293(5):617-619.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Breaking the mould in patient safety
Degos et al.
BMJ 2009;338:b2585-b2585.
FULL TEXT
Lack of Impact of Direct-to-Consumer Advertising on the Physician-Patient Encounter in Primary Care: A SNOCAP Report
Parnes et al.
Ann Fam Med 2009;7:41-46.
ABSTRACT
| FULL TEXT
Electronic Results Management in Pediatric Ambulatory Care: Qualitative Assessment
Ferris et al.
Pediatrics 2009;123:S85-S91.
ABSTRACT
| FULL TEXT
Information exchange among physicians caring for the same patient in the community
van Walraven et al.
CMAJ 2008;179:1013-1018.
ABSTRACT
| FULL TEXT
Computerized Alerts Improve Outpatient Laboratory Monitoring of Transplant Patients
Staes et al.
J. Am. Med. Inform. Assoc. 2008;15:324-332.
ABSTRACT
| FULL TEXT
A theoretical framework and competency-based approach to improving handoffs
Arora et al.
Qual Saf Health Care 2008;17:11-14.
ABSTRACT
| FULL TEXT
Emergency Physicians' Perceptions of Health Information Exchange
Shapiro et al.
J. Am. Med. Inform. Assoc. 2007;14:700-705.
ABSTRACT
| FULL TEXT
Another Lesson From Santa Barbara
Holmquest
Health Aff (Millwood) 2007;26:w592-w594.
ABSTRACT
| FULL TEXT
Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices
Crosson et al.
Ann Fam Med 2007;5:209-215.
ABSTRACT
| FULL TEXT
Ambulatory care adverse events and preventable adverse events leading to a hospital admission
Woods et al.
Qual Saf Health Care 2007;16:127-131.
ABSTRACT
| FULL TEXT
Effect of Provider Continuity on Test Repetition
van Walraven et al.
Clin. Chem. 2006;52:2219-2228.
ABSTRACT
| FULL TEXT
e-Prescribing, Efficiency, Quality: Lessons from the Computerization of UK Family Practice
Schade et al.
J. Am. Med. Inform. Assoc. 2006;13:470-475.
ABSTRACT
| FULL TEXT
It Ain't Necessarily So: The Electronic Health Record And The Unlikely Prospect Of Reducing Health Care Costs.
Sidorov
Health Aff (Millwood) 2006;25:1079-1085.
ABSTRACT
| FULL TEXT
Adherence to black box warnings for prescription medications in outpatients.
Lasser et al.
Arch Intern Med 2006;166:338-344.
ABSTRACT
| FULL TEXT
Informatics Challenges for the Impending Patient Information Explosion
Berner and Moss
J. Am. Med. Inform. Assoc. 2005;12:614-617.
ABSTRACT
| FULL TEXT
Missing Clinical Information: The System Is Down
Elder and Hickner
JAMA 2005;293:617-619.
FULL TEXT
|
