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Impact of a standardized communication system on continuity of care between family physicians and the emergency department

Published online by Cambridge University Press:  21 May 2015

Marc Afilalo ,
Eddy Lang ,
Ruth Léger ,
Xiaoqing Xue ,
Antoinette Colacone ,
Nathalie Soucy ,
Alain Vandal ,
Jean-François Boivin  and
Bernard Unger
Marc Afilalo*
Affiliation:
Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis–Jewish General Hospital, Montréal, Que. Faculty of Medicine, McGill University, Montréal, Que.
Eddy Lang
Affiliation:
Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis–Jewish General Hospital, Montréal, Que. Faculty of Medicine, McGill University, Montréal, Que.
Ruth Léger
Affiliation:
Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis–Jewish General Hospital, Montréal, Que.
Xiaoqing Xue
Affiliation:
Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis–Jewish General Hospital, Montréal, Que.
Antoinette Colacone
Affiliation:
Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis–Jewish General Hospital, Montréal, Que.
Nathalie Soucy
Affiliation:
Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis–Jewish General Hospital, Montréal, Que.
Alain Vandal
Affiliation:
Centre for Clinical Epidemiology and Community Studies Sir Mortimer B. Davis–Jewish General Hospital, Montréal, Que. and the Department of Mathematics and Statistics, McGill University, Montréal, Que.
Jean-François Boivin
Affiliation:
Centre for Clinical Epidemiology and Community Studies Sir Mortimer B. Davis–Jewish General Hospital, Montréal, Que. and the Department of Mathematics and Statistics, McGill University, Montréal, Que.
Bernard Unger
Affiliation:
Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis–Jewish General Hospital, Montréal, Que. Faculty of Medicine, McGill University, Montréal, Que.
*
Emergency Department, SMBD – Jewish General Hospital, Emergency Multidisciplinary Research Unit, 3755, Côte St-Catherine Road D-010, Montreal QC H3T 1E2; marc.afilalo@mcgill.ca

Abstract

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Objective:

It has been suggested that continuity of care is hampered because of the lack of communication between emergency departments (EDs) and primary care providers. A web-based, standardized communication system (SCS) that enables family physicians (FPs) to visualize information regarding their patients' ED visits was developed. This paper aims to evaluate the impact of this SCS on continuity of care.

Methods:

We conducted an open, 4-period crossover, cluster-randomized controlled trial of 23 FP practices. During the intervention phase, FPs received detailed reports via SCS, while in the control phase they received mailed copies of the ED notes. Continuity of care was evaluated with a web questionnaire completed by FPs 21 days after the ED visit. The primary measures of continuity of care were knowledge of ED visit (quality and quantity), patient management and follow-up rate.

Results:

We analyzed a total of 2022 ED visits (1048 intervention and 974 control). The intervention group received information regarding the ED visit more often (odds ratio [OR] 3.14, 95% confidence interval [CI] 2.6–3.79), found the information more useful (OR 5.1, 95% CI 3.49–7.46), possessed a better knowledge of the ED visit (OR 6.28, 95% CI 5.12–7.71), felt they could better manage patients (OR 2.46, 95% CI 2.02–2.99) and initiated actions more often following receipt of information (OR 1.62, 95% CI 1.36–1.93). However, there was no significant difference in the follow-up rate at FPs offices (OR 1.25, 95% CI 0.97–1.61).

Conclusion:

The use of SCS between an ED and FPs led to significant improvements in continuity of care by increasing the usefulness of transferred information and by improving FPs' perceived patient knowledge and patient management.

Keywords

continuity of careemergency departmentfamily physicianfollow-up
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 2 , March 2007 , pp. 79 - 86
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Shortt, S. Reflections on continuity in contemporary Canadian primary care. Can J Nurs Res 2004;36:7–10.Google ScholarPubMed
2.Miller, D. Controlled trial of a geriatric case-finding and liaison service in an emergency department. J Am Geriatr Soc 1996;44: 513–20.CrossRefGoogle ScholarPubMed
3.Pope, D, Fernandes, CM, Bouthillette, F, et al. Frequent users of the emergency department: a program to improve care and reduce visits. CMAJ 2000;162:1017–20.Google ScholarPubMed
4.Freeman, GK, Olesen, F, Hjortdahl, P. Continuity of care: an essential element of modern general practice? Fam Pract 2003;20:623–7.CrossRefGoogle ScholarPubMed
5.Stiell, AP, Forster, AJ, Stiell, IG, et al. Maintaining continuity of care: a look at the quality of communication between Ontario emergency departments and community physicians. Can J Emerg Med 2005;7:155–61.CrossRefGoogle Scholar
6.Donaldson, MS. Continuity of care: a reconceptualization. Med Care Res Rev 2001;58:255–90.Google Scholar
7.Stiell, A, Forster, AJ, Stiell, IG, et al. Prevalence of information gaps in the emergency department and the effect on patient outcomes. CMAJ 2003;169:1023–8.Google ScholarPubMed
8.Dunnion, ME, Kelly, B. From the emergency department to home. J Clin Nurs 2005;14:776–85.CrossRefGoogle Scholar
9.Vinker, S, Kitai, E, Or, Y, et al. Primary care follow up of patients discharged from the emergency department: a retrospective study. BMC Fam Pract 2004;5:16.CrossRefGoogle ScholarPubMed
10.Feied, CF, Smith, MS, Handler, JA, et al. Emergency medicine can play a leadership role in enterprise-wide clinical information systems. Ann Emerg Med 2000;35:162–7.CrossRefGoogle ScholarPubMed
11.Van Walraven, C, Rokosh, E. What is necessary for high-quality discharge summaries? Am J Med Qual 1999;14:160–9.Google Scholar
12.Wass, A R, Illingworth, R N. What information do general practitioners want about accident and emergency patients? J Accid Emerg Med 1996;13:406–8.CrossRefGoogle ScholarPubMed
13.Branger, PJ, van der Wouden, JC, Schudel, BR, et al. Electronic communication between providers of primary and secondary care. BMJ 1992;305:1068–70.CrossRefGoogle ScholarPubMed
14.Nelson, S, 1Lang, G. Virtual records. Using an Internet based system to manage patient records. Nephrol News Issues 2002;16:76–9.Google ScholarPubMed
15.Afilalo, M, Lang, E, Boivin, JF, et al. Communicating clinical information between the emergency department and family physicians: a qualitative analysis of current practices and suggestions for improvement. Annual scientific meeting of CAEP. March 2001. Available: http://www.caep.ca/004.cjem-jcmu/004-00.cjem/vol-3.2001/v32-135-iii.htm (accessed 2006 March 25).Google Scholar
16.Mitchell, E, Sullivan, F, Watt, G, et al. Using electronic patient records to inform strategic decision making in primary care. Medinfo 2004;11:1157–61.Google Scholar
17.Mitchell, E, Sullivan, F, Watt, G, et al. Improving management of hypertension in general practice: a randomized controlled trial of feedback derived from electronic patient data. Br J Gen Pract 2005;55:94–101.Google ScholarPubMed
18.Lang, E, Afilalo, M, Vandal, AC, et al. Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial. CMAJ. 2006;174(3):313–8.Google Scholar
19.Commission on the Future of Health Care in Canada. Building on values. The future of health care in Canada — final report. 2002 Nov 28. Available: www.hcsc.gc.ca/english/pdf/romanow/pdfs/HCC_Final_Report.pdf (accessed 2005 Dec 13).Google Scholar
20.Sin, DD, Bell, NR, Swenson, LW, et al. The impact of follow-up physician visits on emergency readmissions for patients with asthma and chronic obstructive pulmonary disease: a population-based study. Am J Med 2002;112:120–5.CrossRefGoogle ScholarPubMed
21.Weinberger, M, Oddone, EZ, Henderson, WG. Does increased access to primary care reduce hospital readmissions? N Engl J Med 1996;334:1441–7.CrossRefGoogle ScholarPubMed
22.Bouvier, L. Case manager and SIPA the project. Available: http://www.geronto.org/Vitalaging/May2002/sipa.htm (accessed 2006 March 25).Google Scholar
23.Freeman, G, Weaver, T, Low, J, et al. Promoting continuity of care for people with severe mental illness whose needs span primary, secondary and social care. Report for the National Coordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO). October 2001, revised June 2002. Available: http://www.sdo.lshtm.ac.uk/pdf/coc_mentalillness_freeman.pdf (accessed 2006 March 25).Google Scholar
24.Nasmith, L, Coté, B, Cox, J, et al. The challenge of promoting integration: conceptualization, implementation, and assessment of a pilot care delivery model for patients with type 2 diabetes. Fam Med 2004;36:40–5.Google Scholar
25.Laurence, CO, Beilby, J, Campbell, S, et al. Process for improving the integration of care across the primary and acute care settings in rural South Australia: asthma as a case study. Aust J Rural Health 2004;12:264–8.CrossRefGoogle ScholarPubMed
26.Christakis, DA, Wright, JA, Zimmerman, FJ, et al. Continuity of care is associated with high-quality care by parental report. Pediatrics 2002;109:e54.CrossRefGoogle ScholarPubMed
27.Parchman, ML, Burge, SK, Residency Research Network of South Texas Investigators. Continuity and quality of care in type 2 diabetes: a Residency Research Network of South Texas study. J Fam Pract 2002;51:619–24.Google Scholar
28.Cabana, MD, Jee, SH. Does continuity of care improve patient outcomes? J Fam Pract 2004;53:974–80.Google Scholar
29.Parchman, ML, Pugh, JA, Noel, PH, et al. Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes. Med Care 2002;40:137–44.CrossRefGoogle ScholarPubMed
30.Christakis, DA, Mell, L, Wright, JA, et al. The association between greater continuity of care and timely measles-mumpsrubella vaccination. Am J Public Health 2000;90:962–5.Google Scholar
31.Tamblyn, R, Huang, A, Perreault, R, et al. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ 2003;169:549–56.Google ScholarPubMed