| Title |
The Impact of Automated Notification on Follow-up of Actionable Tests Pending at Discharge: a Cluster-Randomized Controlled Trial
|
|---|---|
| Published in |
Journal of General Internal Medicine, March 2018
|
| DOI | 10.1007/s11606-018-4393-y |
| Pubmed ID | |
| Authors |
Anuj K. Dalal, Adam Schaffer, Esteban F. Gershanik, Ranganath Papanna, Katyuska Eibensteiner, Nyryan V. Nolido, Cathy S. Yoon, Deborah Williams, Stuart R. Lipsitz, Christopher L. Roy, Jeffrey L. Schnipper |
| Abstract |
Follow-up of tests pending at discharge (TPADs) is poor. We previously demonstrated a twofold increase in awareness of any TPAD by attendings and primary care physicians (PCPs) using an automated email intervention OBJECTIVE: To determine whether automated notification improves documented follow-up for actionable TPADs DESIGN: Cluster-randomized controlled trial SUBJECTS: Attendings and PCPs caring for adult patients discharged from general medicine and cardiology services with at least one actionable TPAD between June 2011 and May 2012 INTERVENTION: An automated system that notifies discharging attendings and network PCPs of finalized TPADs by email MAIN MEASURES: The primary outcome was the proportion of actionable TPADs with documented action determined by independent physician review of the electronic health record (EHR). Secondary outcomes included documented acknowledgment, 30-day readmissions, and adjusted median days to documented follow-up. Of the 3378 TPADs sampled, 253 (7.5%) were determined to be actionable by physician review. Of these, 150 (123 patients discharged by 53 attendings) and 103 (90 patients discharged by 44 attendings) were assigned to intervention and usual care groups, respectively, and underwent chart review. The proportion of actionable TPADs with documented action was 60.7 vs. 56.3% (p = 0.82) in the intervention vs. usual care groups, similar for documented acknowledgment. The proportion of patients with actionable TPADs readmitted within 30 days was 22.8 vs. 31.1% in the intervention vs. usual care groups (p = 0.24). The adjusted median days [95% CI] to documented action was 9 [6.2, 11.8] vs. 14 [10.2, 17.8] (p = 0.04) in the intervention vs. usual care groups, similar for documented acknowledgment. In sub-group analysis, the intervention had greater impact on documented action for patients with network PCPs compared with usual care (70 vs. 50%, p = 0.03). Automated notification of actionable TPADs shortened time to action but did not significantly improve documented follow-up, except for network-affiliated patients. The high proportion of actionable TPADs without any documented follow-up (~ 40%) represents an ongoing safety concern. NCT01153451. |
X Demographics
The data shown below were collected from the profiles of 25 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 10 | 40% |
| Canada | 2 | 8% |
| United Kingdom | 2 | 8% |
| Spain | 1 | 4% |
| Unknown | 10 | 40% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 12 | 48% |
| Scientists | 6 | 24% |
| Practitioners (doctors, other healthcare professionals) | 6 | 24% |
| Science communicators (journalists, bloggers, editors) | 1 | 4% |
Mendeley readers
The data shown below were compiled from readership statistics for 44 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 44 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 6 | 14% |
| Other | 6 | 14% |
| Student > Bachelor | 5 | 11% |
| Researcher | 3 | 7% |
| Student > Ph. D. Student | 3 | 7% |
| Other | 7 | 16% |
| Unknown | 14 | 32% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 12 | 27% |
| Nursing and Health Professions | 8 | 18% |
| Computer Science | 2 | 5% |
| Arts and Humanities | 2 | 5% |
| Psychology | 2 | 5% |
| Other | 3 | 7% |
| Unknown | 15 | 34% |
Attention Score in Context
This research output has an Altmetric Attention Score of 44. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 July 2019.
All research outputs
#857,786
of 23,911,072 outputs
Outputs from Journal of General Internal Medicine
#720
of 7,806 outputs
Outputs of similar age
#20,523
of 335,921 outputs
Outputs of similar age from Journal of General Internal Medicine
#26
of 152 outputs
Altmetric has tracked 23,911,072 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 7,806 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 21.8. This one has done particularly well, scoring higher than 90% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 335,921 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 152 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 82% of its contemporaries.