Content and application of the computerized Problem List in different user populations in family medicine.

摘要

Problem. The Problem List is widely regarded as an important component of a Computer-based Patient Record system, yet its content and use is neither well documented nor understood. The goal of this research is to construct a process that can be used to bring clarity to the definition of what the Problem List is and how it should function as part of a Computer-based Patient Record system. It approaches the task of definition by studying a population of individuals who work in a single clinical environment. By measuring agreement and disagreement between members of this population, the research defines what the Problem List must contain and subsequently what it must accomplish for the different groups of individuals who use it.; Methods. The setting of the study is a family medicine clinic in a large academic medical center that has continuously used a computerized Problem List since 1975. Twenty-four Problem Types and nine Applications of the Problem List were hypothesized and evaluated. A cross-sectional study design was implemented using both a survey instrument and database query. All 133 members of the clinic were surveyed with a response rate of 79%. The query included 107,099 patients who had 1,570,557 Problems recorded in the computerized Problem List between January 1989 and December 1998.; Conclusions. Of the hypothesized Problem Types, seven were confirmed (Allergies, Diagnoses, Disabilities, History of, Procedures, Psychiatric, Risk Factors), five were rejected (Economic, Name of Patient's Pet, Patient Complaint, Patient Preference, Religion), and conclusions could not be drawn regarding the remaining ten. Five additional Problem Types were operationally confirmed (Administrative, Counseling, Medications, Vaccination, Wellness). The survey instrument is validated as a measure of the content of the Problem List. Of the hypothesized Applications, Clinical Provider valued the Problem List to Managing a Single Patient. Technicians, Researchers and Administrators valued the Problem List to Document the Encounter. Clerical staff valued it to Plan the Encounter. Additional conclusions are drawn regarding Problem List design and the use of the methods of this study as a surveillance tool, an operational tool and a performance tool.