Enhancing Providers' Ability to Follow Up on Abnormal Test Results (North Carolina)

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Summary:

Mammograms and Papanicolaou (Pap) smears can improve patient outcomes for breast and cervical cancer. Appropriate and timely follow up of abnormal results must occur to achieve the full benefit of cancer screening; however, follow up is frequently inadequate. Electronic health records (EHRs) with alerts and reminders for abnormal results can improve timely follow up of abnormal test results; nonetheless, even when providers acknowledge abnormal results, some patients still do not receive timely follow up. The problem is a multifaceted safety issue that occurs within the complex “sociotechnical” system of healthcare, involving complex interactions between providers, patients, the EHR, workflows, and organizational factors. Additionally, cross-coverage scenarios in which providers receive abnormal results for other providers’ patients increase the likelihood that follow ups are not completed.

This project conducted a randomized controlled trial to assess provider workload and performance during abnormal test results-based tasks in a standard EHR environment versus an enhanced EHR environment, under regular-coverage and cross-coverage scenarios. The enhanced EHR environment had a “result tracking” function that allowed providers to closely monitor critical abnormal test results and was not available in the standard EHR environment.

The specific aim of this project was as follows:

  • Subjectively and objectively assess provider mental workload and performance during abnormal test results-based tasks in a baseline EHR environment versus an enhanced EHR environment with results tracking functionality under regular-coverage and cross-coverage scenarios. 

When providers were presented with a high-volume of abnormal test results, task demands, providers’ perception of workload, and time to complete the scenarios increased significantly. Cross-covering providers experienced twice the volume of alerts of compared to the non-cross-covering providers and their clinical performance degraded when tracking and following up on patients with planned diagnostic evaluation. The enhanced EHR environment with results tracking functionality resulted in significant improvements in clinical performance and physiological workload. Overall, fatigue levels affected performance, especially for participants indicating low or high fatigue levels.

Results suggest that longitudinal monitoring and tracking of abnormal test results and patient status can help ensure appropriate follow up of abnormal test results. Additional research is needed to quantify effects of innovative functionality and usability features for ensuring appropriate acknowledgment and follow up of abnormal test results.

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Enhancing Providers' Ability to Follow-up on Abnormal Test Results - Final Report

Citation:
Mazur L. Enhancing Providers' Ability to Follow-up on Abnormal Test Results - Final Report. (Prepared by the University of North Carolina Chapel Hill under Grant No. R21 HS024062). Rockville, MD: Agency for Healthcare Research and Quality, 2017. (PDF, 632.73 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. 
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