Objectives
To describe the management of and satisfaction with laboratory testing, and desirability
of laboratory health information technology in the nursing home setting.
Design
Cross-sectional study using an Internet-based survey.
Participants and Setting
National sample of 426 nurse practitioners and 308 physicians who practice in the
nursing home setting.
Measurements
Systems and processes available for ordering and reviewing laboratory tests, laboratory
test result management satisfaction, self-reported delays in laboratory test result
review, and desirability of computerized laboratory test result management features
in the nursing home setting.
Results
A total of 96 participants (48 physicians and 48 nurse practitioners) completed the
survey, for an overall response rate of 13.1% (96/734). Of the survey participants,
77.1% had worked in the nursing home setting for more than 5 years. Over half of clinicians
(52.1%) reported 3 or more recent delays in receiving laboratory test results. Only
43.8% were satisfied with their laboratory test results management. Satisfaction was
associated with keeping a list of laboratory orders and availability of computerized
laboratory test order entry. In the nursing home, 35.4% of participants reported the
ability to electronically review laboratory test results, 12.5% and 10.4% respectively
had computerized ordering of chemistry/hematology and microbiology/pathology tests.
The following 3 features were rated most desirable in a computerized laboratory test
result management system: showing abnormal results first, warning if a test result
was missed, and allowing electronic acknowledgment of test results.
Conclusion
Delays in receiving laboratory test results and dissatisfaction with the management
of laboratory test result information are commonly reported among physicians and nurse
practitioners working in nursing homes. Test result management satisfaction was associated
with computerized order entry and keeping track of ordered laboratory tests, suggesting
that implementation of certain health information technology could potentially improve
quality of care.
Keywords
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References
- Patient notification and follow-up of abnormal test results.Arch Intern Med. 1996; 156: 327-331
- Primary care physician attitudes concerning follow-up of abnormal test results and ambulatory decision support systems.Int J Med Inform. 2003; 71: 137-149
- Follow-up of outpatient test results: A survey of house-staff practices and perceptions.Am J Med Qual. 2006; 21: 178-184
- “I wish I had seen this test result earlier!”: Dissatisfaction with test result management systems in primary care.Arch Intern Med. 2004; 164: 2223-2228
- Patient safety in the ambulatory setting.J Gen Intern Med. 2004; 19: 719-725
- Massachusetts emergency medicine closed malpractice claims: 1988–1990.Ann Emerg Med. 1993; 22: 553-559
- National estimates of medication use in nursing homes: Findings from the 1997 Medicare current beneficiary survey and the 1996 medical expenditure survey.J Am Geriatr Soc. 2005; 53: 438-443
- Risk factors for adverse drug events among nursing home residents.Arch Intern Med. 2001; 161: 1629-1634
- Adverse drug reactions: Definitions, diagnosis, and management.Lancet. 2000; 356: 1255-1259
- Epidemiology of medication-related adverse events in nursing homes.Am J Geriatr Pharmacother. 2006; 4: 264-272
- Incidence and preventability of adverse drug events in nursing homes.Am J Med. 2000; 109: 87-94
- The incidence of adverse drug events in two large academic long-term care facilities.Am J Med. 2005; 118: 251-258
- Physician practice patterns in nursing homes.J Am Med Dir Assoc. 2007; 8: 558-567
- Measuring staff turnover in nursing homes.Gerontologist. 2006; 46: 210-219
- Nursing home staff turnover: Impact on nursing home compare quality measures.Gerontologist. 2007; 47: 650-661
- Assessing and collecting data on nursing facility patients: A guide for nurses on effective communication with physicians.American Medical Directors Association, Columbia, MD2004
- Barriers to effective communication in skilled nursing facilities: Differences in perception between nurses and physicians.J Am Geriatr Soc. 1999; 47: 71-75
- After-hours calls from long-term care facilities in a geriatric medicine training program.J Am Geriatr Soc. 2007; 55: 1989-1994
- Inter-disciplinary focus groups on telephone medicine: A quality improvement initiative.J Am Med Dir Assoc. 2006; 7: 407-411
- Notifying emergency department patients of negative test results: Pitfalls of passive communication.Pediatr Emerg Care. 2003; 19: 226-230
- Fundamentals of Biostatistics.6th ed. Duxbury Press, Boston, MA2005
- Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care.Ann Intern Med. 2006; 144: 742-752
- Effect of computerized physician order entry and a team intervention on prevention of serious medication errors.JAMA. 1998; 280: 1311-1316
- Computerised pathology test order entry reduces laboratory turnaround times and influences tests ordered by hospital clinicians: A controlled before and after study.J Clin Pathol. 2006; 59: 533-536
- Randomized trial to improve laboratory safety monitoring of ongoing drug therapy in ambulatory patients.Pharmacotherapy. 2006; 26: 619-626
- The costs of a national health information network.Ann Intern Med. 2005; 143: 165-173
- Assessing the level of healthcare information technology adoption in the United States: A snapshot.BMC Med Inform Decis Mak. 2006; 6: 1
- Electronic health records in ambulatory care—a national survey of physicians.N Engl J Med. 2008; 359: 50-60
- Computerized physician order entry with clinical decision support in long-term care facilities: Costs and benefits to stakeholders.J Am Geriatr Soc. 2007; 55: 1451-1457
- Factors associated with the use of electronic information systems for drug dispensing and medication administration records in nursing homes.J Am Med Dir Assoc. 2008; 9: 414-421
- Increasing response rates to postal questionnaires: Systematic review.BMJ. 2002; 324: 1183
- A very low response rate in an on-line survey of medical practitioners.Aust N Z J Public Health. 2008; 32: 288-289
- Mixing web and mail methods in a survey of physicians.Health Serv Res. 2007; 42: 1219-1234
Article info
Publication history
Published online: January 09, 2009
Footnotes
This study was supported in part by National Institutes of Health (NIH) grants F30MH074265, 1 KL2 RR024154–01 (NIH Roadmap Multidisciplinary Clinical Research Career Development Award Grant), P30AG024827, R01AG027017, and F30MH074265; a Merck/AFAR Junior Investigator Award in Geriatric Clinical Pharmacology; and a Veteran's Administration Health Services Research and Development Service Merit Award (IIR06–062). The authors acknowledge no conflicts of interest.
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© 2009 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
