Effect of an Electronic Health Record Transition on the Provision of Recommended Well Child Services in Pediatric Primary Care Practices.

We sought to determine the effect of transitioning between electronic health record (EHR) systems on the quality of preventive care in a large pediatric primary care network. To study this, we performed a retrospective chart analysis of 42 primary care practices from the Pediatric Physicians' Organization at Children's who transitioned EHRs. We reviewed 24 random encounters per week distributed evenly across 6 age categories before, during, and after a transition period. We reviewed encounter documentation for age-appropriate well child services, per American Academy of Pediatrics/Bright Futures guidelines. Logistic regression and statistical process control analysis were used. In the pretransition period, 84.5% of all recommended elements were documented versus 86.4% posttransition (P = .04). Documentation of age-appropriate anticipatory guidance showed significant positive change (69.0% to 80.2%, P = .005), but it was the only subdomain with a statistically significant increase. These increases suggest that EHR transitions have the opportunity to affect the delivery of preventive care.

Case management reform: an illustrative study of one hospital's experience.

PRIMARY PRACTICE SETTINGS: This study describes reform of the case management department at Cooley Dickinson Hospital, a small community hospital in Western Massachusetts. METHODOLOGY AND SAMPLE: Based on Microsystems and Care Transition theory, the study is designed to answer 2 primary research questions: (1) What is study participants' perceived value of the recent departmental changes? and (2) What effect have the changes had on participants' work experience? A sample of case management department staff members and several other hospital staff members were interviewed near the end of the 18-month reform process, in March 2009. RESULTS: Results of these interviews indicate that despite a departmentwide reduction in force in November 2008, case management productivity levels have increased and satisfaction levels remain strong. It is strongly believed by study observers that because the changes used proven theories, the efficiencies and satisfaction that were realized can be duplicated in other settings. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE AND RESEARCH: Findings have practical implications for the use of a model similar to the Congestive Heart Failure program model to improve care transitions across multiple sites through a patient-centered team approach. In particular, findings underscore the importance of improved use of information technologies for a more efficient transmission of information to postacute providers and the use of follow-up telephone calls. Another practical implication is the benefit of education of hospital staff about the impact the case management department has on the hospital as a whole. Improved education of hospitalists, specifically, has resulted in earlier communication on the nursing units and more efficient discharge processes. There are also implications for research, such as the need for further research on the effects of patient-centered care for reducing readmission and on the definition and treatment of complex cases across hospital units.