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The PCPs in the control arm were provided with information about their patients’ ED visits through a mailed carbonated copy of ED notes which is standard procedure at the ED of SMBD- JGH. The PCPs in the intervention arm, were notified (through SCS) about their patients’ ED visits and could get medical information specific to those visits. One week prior to every crossover, family physicians received a letter advising them when the cross-over would occur. Status (intervention or control) of PCPs was changed (administrator access level) on the cross-over date; blinding (control) or permitting (intervention) them to know about their patients’ ED visits. Sample size determinations Sample size estimations were based on the expected change in the incidence of return visits to the ED and ED length of stay (LOS) of patients recruited in the control and intervention arms. The incidence of return visits within 14 days was estimated at 14% and that of LOS at 9 hours from JGH statistics. Using a power of 80% and an alpha of 5%, the study would be sensitive to a minimum absolute difference of 5% in return visits to ED and a 1.8 hours decrease in LOS with a sample size of 1000 visits per group. Family physician sampling Family physicians (FP) whose patients visited the emergency department most frequently were approached for participation in the study. In all three centres, 70 family physicians were invited to participate. Although the study could only be done at the JGH, family physicians from the other two centres had expressed an interest in participating. The FPs were made aware that their participation would involve the following: a one year commitment to the study, answering a general questionnaire before and after the study (annex F), checking their email on a daily basis, having or not access to the SCS intermittently and responding to an electronic questionnaire for each patient visit to the ED. FPs were equipped with computers, printers, appropriate software as well as internet hook-up. Access to the web was made available for them through a telephone line. All family physicians were given a “step by step” manual (annex G) and had a 2 hour training session by the study coordinator. 11
Questionnaire development Questionnaires were developed to evaluate the impact of SCS on our primary and secondary outcomes. In all, five questionnaires (annex F) were developed. Table 2 indicates who completed the questionnaires and when. Table 2 : Study questionnaires. Questionnaire Person that completed Time of completion Electronic Family physician 21 days after patient ED visit Patient satisfaction day 1 Patient Visit to ED Patient satisfaction day 21 Patient By telephone 21 days after ED visit FP Pre Study Family physician Through pre focus group FP Post study Family physician Through post focus group The electronic questionnaire was developed to assess resource utilization out of the ED, any duplication of test ordering, continuity of care (knowledge of patient health status, follow-up of ED care) and PCP satisfaction (knowledge, patient management, etc). The electronic questionnaire was sent through an e-mail link and answered via the internet (annex F). The SCS tool sent a link to the PCP (email) allowing him/her to respond to a maximum of 21 questions. Internet questionnaire was chosen to make it less time consuming for PCP. The PCPs stated that it took about 10 minutes to answer and submit a questionnaire. The patient satisfaction day 1 questionnaire was completed when the patient was recruited in the ED, the day 21 questionnaire was done by telephone. These 2 questionnaires assessed patient satisfaction with respect to the communication between FP and EP, perception of FP’s knowledge about ED visit, perception of family physician, perception of pain and severity of illness, use of health care system, access to health care system and socio demographic information. The questionnaires were <strong>des</strong>ign to be filled out by the patients directly or with the help of the RA. The ED questionnaire took approximately 25 minutes to complete. Pre and post study questionnaires were aimed at collecting PCP socio demographic information and assessing their appreciation of the outcomes which are also measured in the electronic 12
Page 1 and 2: The Impact of a Standardized Inform
Page 3 and 4: The Impact of a Standardized Inform
Page 5 and 6: Executive Summary Context Inadequat
Page 7 and 8: 4. Do patients value the standardiz
Page 9 and 10: key information (test results, cons
Page 11 and 12: to an absence of an efficient commu
Page 13 and 14: Managers in the hospital-based and
Page 15 and 16: Call for tenders A document incorpo
Page 17: Implementation of the tool Sir Mort
Page 21 and 22: Information transfer from ED to PCP
Page 23 and 24: account for this repeated measureme
Page 25 and 26: A post study focus group was held t
Page 27 and 28: In comparison with mailed copies of
Page 29 and 30: Visit to PCP and reason of visit 80
Page 31 and 32: methods that are seamless and bi-di

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