许多医疗条件,也许其中80%,可以通过全面的现病史(HPI)来诊断。然而,在临床环境中,中断和时间压力等情境因素可能导致与患者的互动简短且支离破碎.提高临床医生收集全面HPI并最大限度地提高护理效率和质量的能力的一个解决方案是在临床医生进行面对面评估之前使用数字工具获得HPI。
我们的目标是识别和表征旨在直接从患者或护理人员那里获得HPI的数字工具,并在面对面接触之前将这些信息呈现给临床医生。我们还试图描述这些工具测试中报告的结果,尤其是那些与可用性相关的,效率,和护理质量。
我们在以下数据库中使用预定义的搜索词进行了范围审查:MEDLINE,CINAHL,PsycINFO,WebofScience,Embase,IEEEXplore数字图书馆,ACM数字图书馆,和ProQuest学位论文和论文全球。两名审稿人筛选了标题和摘要的相关性,对符合纳入标准的文章进行全文审查,并使用堆排序程序来识别工具的区别特征。描述工具的信息主要是从确定的同行评审来源获得的;此外,补充信息是从工具网站以及通过与工具创建者的直接通信获得的。
我们确定了18种符合纳入标准的工具。在这18个工具中,14(78%)主要使用封闭式和多项选择题,1(6%)使用自由文本输入,3人(17%)使用会话(聊天机器人)风格。超过一半(10/18,56%)的工具是针对特定患者亚群定制的;其余(8/18,44%)的工具没有指定目标亚群。在18个工具中,7(39%)包括多语言支持,12人(67%)有能力直接将数据传输到电子健康记录中。对与可用性相关的各种结果度量报告的工具的研究,效率,和护理质量。
我们确定的HPI工具(N=18)的目的和功能差异很大。关于应如何收集或向临床医生提供患者生成的信息尚未达成共识。现有的工具经历了不一致的测试水平,在评估中使用了各种各样不同的结果衡量标准,包括一些与可用性相关的,效率,和护理质量。人们对使用数字工具从患者那里获得HPI有很大的兴趣,但是测量的结果不一致。未来的研究应该集中在使用HPI工具是否可以改善患者体验和健康结果。尽管只要监测患者安全,也可以使用替代终点.
Many medical conditions, perhaps 80% of them, can be diagnosed by taking a thorough history of present illness (HPI). However, in the clinical setting, situational factors such as interruptions and time pressure may cause interactions with patients to be brief and fragmented. One solution for improving clinicians\' ability to collect a thorough HPI and maximize efficiency and quality of care could be to use a digital tool to obtain the HPI before face-to-face evaluation by a clinician.
Our objective was to identify and characterize digital tools that have been designed to obtain the HPI directly from patients or caregivers and present this information to clinicians before a face-to-face encounter. We also sought to describe outcomes reported in testing of these tools, especially those related to usability, efficiency, and quality of care.
We conducted a scoping
review using predefined search terms in the following databases: MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, IEEE Xplore Digital Library, ACM Digital Library, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts for relevance, performed full-text reviews of articles meeting the inclusion criteria, and used a pile-sorting procedure to identify distinguishing characteristics of the tools. Information describing the tools was primarily obtained from identified peer-reviewed sources; in addition, supplementary information was obtained from tool websites and through direct communications with tool creators.
We identified 18 tools meeting the inclusion criteria. Of these 18 tools, 14 (78%) used primarily closed-ended and multiple-choice questions, 1 (6%) used free-text input, and 3 (17%) used conversational (chatbot) style. More than half (10/18, 56%) of the tools were tailored to specific patient subpopulations; the remaining (8/18, 44%) tools did not specify a target subpopulation. Of the 18 tools, 7 (39%) included multilingual support, and 12 (67%) had the capability to transfer data directly into the electronic health record. Studies of the tools reported on various outcome measures related to usability, efficiency, and quality of care.
The HPI tools we identified (N=18) varied greatly in their purpose and functionality. There was no consensus on how patient-generated information should be collected or presented to clinicians. Existing tools have undergone inconsistent levels of testing, with a wide variety of different outcome measures used in evaluation, including some related to usability, efficiency, and quality of care. There is substantial interest in using digital tools to obtain the HPI from patients, but the outcomes measured have been inconsistent. Future research should focus on whether using HPI tools can lead to improved patient experience and health outcomes, although surrogate end points could instead be used so long as patient safety is monitored.