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Tytuł:
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Adoption of a laboratory EMR system and inappropriate laboratory testing in Ontario: a cross-sectional observational study.
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Autorzy:
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Chami N; Ontario Medical Association, Economics, Policy & Research Department, 150 Bloor St. W, Suite 900, Toronto, ON, M5S 3C1, Canada. .
Mathew S; MyFamilyMD, 396 St. Clair Ave. W, Toronto, ON, M5P 3N3, Canada.
Weir S; Ontario Medical Association, Economics, Policy & Research Department, 150 Bloor St. W, Suite 900, Toronto, ON, M5S 3C1, Canada.
Wright JG; Ontario Medical Association, Economics, Policy & Research Department, 150 Bloor St. W, Suite 900, Toronto, ON, M5S 3C1, Canada.
Kantarevic J; Ontario Medical Association, Economics, Policy & Research Department, 150 Bloor St. W, Suite 900, Toronto, ON, M5S 3C1, Canada.
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Źródło:
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BMC health services research [BMC Health Serv Res] 2021 Apr 06; Vol. 21 (1), pp. 307. Date of Electronic Publication: 2021 Apr 06.
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Typ publikacji:
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Journal Article; Observational Study
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Język:
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English
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Imprint Name(s):
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Original Publication: London : BioMed Central, [2001-
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MeSH Terms:
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Physicians, Primary Care*
Diagnostic Tests, Routine ; Electronic Health Records ; Humans ; Medical Overuse ; Ontario ; Primary Health Care
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References:
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Contributed Indexing:
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Keywords: EMR; Inappropriate laboratory testing; Primary care models
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Entry Date(s):
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Date Created: 20210407 Date Completed: 20210514 Latest Revision: 20220531
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Update Code:
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20240104
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PubMed Central ID:
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PMC8025377
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DOI:
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10.1186/s12913-021-06296-5
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PMID:
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33823869
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Background: Electronic medical record (EMR) systems have the potential to facilitate appropriate laboratory testing. We examined three common medical tests in primary care-hemoglobin A1c (HbA1c), lipid, and thyroid stimulating hormone (TSH)- to assess whether adoption of a laboratory EMR system in Ontario had an impact on the rate of inappropriate testing among primary care physicians.
Methods: We used FY2016-17 population-level laboratory data to estimate the association between adoption of a laboratory EMR system and the rate of inappropriate testing. Inappropriate testing was assessed based on recommendations for screening, monitoring, and follow-up that take into account risk factors related to patient age and certain clinical conditions. To overcome the problem of potential endogeneity of physician choice to use the EMR, the EMR penetration rate in the physician's geographical area of practice was used as an instrumental variable in an ordinary least squares (OLS) regression. We then simulated the change in the rate of inappropriate testing, by physician payment model, as the EMR penetration rate increased from the baseline percentage.
Results: The simulation models showed that an increase in the rate of EMR penetration from a baseline average was associated with a statistically significant decrease in inappropriate hbA1c and lipid testing, but a statistically insignificant increase in inappropriate TSH testing. The impact of EMR penetration also varied by payment model.
Conclusions: This study demonstrated a positive association between availability of an EMR system and appropriate service utilization. Varying impacts of the EMR system availability by primary care payment model may be reflective of different incentives or attributes inherent in payment models. Policies to encourage physicians to increase their use of laboratory EMR systems could improve the quality and continuity of patient care.
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