Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial

Lang, E.

doi:10.1503/cmaj.050698

Cited by 60Electronic Health Records SystemsEmergency and Acute Care StudiesHealthcare Systems and Technology

Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial

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Lang, E.·2006·Canadian Medical Association Journal

DOI 10.1503/cmaj.050698PMC PMC1373712

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Abstract

BACKGROUND: Electronic information exchange is believed to improve efficiency and reduce resource utilization. We developed a Web-based standardized communication system (SCS) that enables family physicians to receive detailed reports of their patients' care in the emergency department. We sought to determine the impact of the SCS on measures of resource utilization in the emergency department and family physician offices. METHODS: We used an open 4-period crossover cluster-randomized controlled design. During 2 separate 10-week intervention phases, family physicians received detailed reports of their patients' emergency department visits over the Internet, and in the alternating control phases they received a 1-page copy of the emergency department notes by mail. The primary outcome was the number of repeat visits to the emergency department within 14 days of the initial visit. Secondary outcomes included duplication of test and specialty consultation requests by the emergency and family physician. Outcomes were measured using the hospital database and questionnaires sent to the family physicians. RESULTS: A total of 2022 patient visits to the emergency department from 23 practices were used in the study. Use of the SCS failed to reduce the number of repeat visits to the emergency department within 14 days (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.8-1.51) and 28 days (OR 1.01, 95% CI 0.8-1.27). There was no significant duplication of requests for diagnostic tests between the emergency and family physician during the intervention and control phases (24 v. 22, p = 0.93), but there was significantly greater duplication in specialty consultation requests in the intervention phase than in the control phase (20 v. 8, p = 0.049). INTERPRETATION: An electronic link between emergency and family physicians did not result in a significant reduction in resource utilization at either service point. Investments in improved electronic information exchange between emergency departments and family physician offices may not be substantiated by a reduction in resource utilization.

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In a Canadian crossover cluster randomized study (n=2,022 patient visits), availability of emergency department information to family physicians did not result in duplication of requests for diagnostic tests, but rather a greater duplication in specialty consultation requests.
“The results indicated that the availability of this information did not result in duplication of requests for diagnostic tests, but rather a greater duplication in specialty consultation requests.”
From The Empirical Foundations of Telemedicine Interventions in Primary Care (2016) · cites this paper as [84]
In that Canadian study, whereas family physicians in the intervention group appreciated having the information, there was no evidence that it resulted in reduced resource use.
“Whereas family physicians in the intervention group appreciated having this information, there was no evidence that it resulted in reduced resource use.”
From The Empirical Foundations of Telemedicine Interventions in Primary Care (2016) · cites this paper as [84]

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Authors: Lang, E.
Affiliations: Jewish General Hospital (CA)
Corresponding author: Lang, E.
ORCID: Lang, E.
Venue: Canadian Medical Association Journal
Publisher: CMA Joule Inc.
Published: 2006-01-31
Volume: 174
Issue: 3
Pages: 313-318
ISSN: 0820-3946 (ISSN-L)
1488-2329
DOI: 10.1503/cmaj.050698
PMC: PMC1373712
OpenAlex: W2118347789
Cited by: 60
References: 17
Citations by year: 2026: 1 · 2024: 1 · 2023: 1 · 2021: 1 · 2020: 3 · 2019: 5 · 2018: 2 · 2017: 3 · 2016: 5 · 2015: 5 · 2014: 4 · 2013: 5 · 2012: 2
FWCI: 9.48
Type: journal article
Language: en
Open access: gold
doi.org
Locations: Canadian Medical Association Journal (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: McGill University
Jewish General Hospital
Topics: Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords: health information exchange, emergency department, general practitioners, online communication, resource utilization (health care), repeat emergency department visits, continuity of care, care coordination
MeSH terms: Adolescent, Adult, Aged, Data Collection, Emergency Service, Hospital, Family Practice, Female, Health Services, Humans, Information Services, Interprofessional Relations, Male, Middle Aged, Office Visits, Medical Records Systems, Computerized, Cross-Over Studies, Internet

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Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial

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