Development and evaluation of notifications to inform primary care providers of summary documentation for their patients' hospital visits

The transition of care patients experience when they are discharged from inpatient or emergency department (ED) care often suffers from poor communication that has the potential to result in adverse events. The purpose of this dissertation was to design and evaluate a system to notify the primary care provider (PCP) named in a patient's admission record when new discharge summary documentation is stored to their patients' electronic medical records (EMRs). This system was built and evaluated within the Intermountain Healthcare HELP2 EMR system.;A randomized controlled trial (RCT) of the system was conducted in which six clinics were selected and randomly assigned to a control or intervention group. Providers at intervention clinics were sent notifications when summary documentation was created for hospital encounters for which they were named as a patient's PCP.;A concurrent study found that other data types might outperform the current method of predicting follow-up providers (using the PCP named in the patient's admission record). The best performing predictor of future follow-up records was a patient's past appointment history. Unfortunately, even this "best" predictor only had a sensitivity of 48% and a positive predictive value of 34%.;The final RCT analysis found that provider access of summary documents was significantly higher among intervention group providers than among control providers (80% of discharge summaries and 56% of ED summaries, compared to 65% and 25%) and occurred significantly sooner. Follow-up care process outcomes, including time from discharge to follow-up, and hospital and emergency readmission rates, were also measured, but no significant improvement was seen in the intervention group. A survey of intervention providers showed high rates of satisfaction with the system.;The notifications were a simple, yet effective, means of improving communication at the discharge transition. It is possible that improvement in follow-up care processes might also be seen if the notifications are updated to include mechanisms for acting on this new information. However, without changes in primary care reimbursement, PCPs will still be hard-pressed to find time for preventive care.;Future plans include updates to the notification design, and an expansion to include notifications for other clinical events.