The impact of an integrated hospital-community medical information system on quality of care and medical service utilisation in primary-care clinics

Nirel, Nurit; Rosen, Bruce; Sharon, Assaf; Samuel, Hadar; Cohen, Arnon D

doi:10.3109/17538157.2010.535130

Cited by 14 publications

(8 citation statements)

References 10 publications

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“…The aim of our study was to examine the outcome of a large thyroid cohort, which either underwent surgery or clinical follow‐up based on a holistic approach that integrates clinical, sonographic, and cytological parameters. Our study reports the outcome of large thyroid nodules, with novel data on the natural course of these nodules and the outcome of community‐based follow‐up, using an integrated data system (Ofek Ltd., Clalit Health Services, Tel Aviv, Israel) . This system enables real‐time monitoring of community‐based follow‐ups.…”

Section: Discussionmentioning

confidence: 99%

“…Our study reports the outcome of large thyroid nodules, with novel data on the natural course of these nodules and the outcome of community-based follow-up, using an integrated data system (Ofek Ltd., Clalit Health Services, Tel Aviv, Israel). 20 This system enables real-time monitoring of community-based follow-ups. Very few studies have focused on long-term outcomes of large thyroid nodules.…”

Section: Discussionmentioning

confidence: 99%

“…Evaluation of follow‐up and outcome of the cohort was conducted by using two separate EMRs: The institute's (Chameleon, Elad Solutions Ltd. Tel Aviv, Israel) and an intergraded hospital‐community online medical records system (Ofek database system, Clalit Health Services, Tel Aviv, Israel), which allows online access to imaging, pathological reports, lab reports, admissions, and community visits . For validation, we cross‐checked the data for all patients who underwent surgery in our institution, by confirming the diagnosis of surgery and pathology in the Ofek EMR.…”

Section: Methodsmentioning

confidence: 99%

“…Evaluation of follow-up and outcome of the cohort was conducted by using two separate EMRs: The institute's (Chameleon, Elad Solutions Ltd. Tel Aviv, Israel) and an intergraded hospital-community online medical records system (Ofek database system, Clalit Health Services, Tel Aviv, Israel), which allows online access to imaging, pathological reports, lab reports, admissions, and community visits. 20 For validation, we cross-checked the data for all patients who underwent surgery in our institution, by confirming the diagnosis of surgery and pathology in the Ofek EMR. For each patient, the following was obtained: diagnoses made in the community clinic/hospitalizations (in our institution or others), history of surgeries, pathological reports, hospital admissions, and discharges, imaging, community physician visits, date of death, and reason of death for deceased patients.…”

Section: Methodsmentioning

confidence: 99%

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Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

et al. 2019

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Background The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors. Methods All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow‐up data were collected using an integrated hospital‐community system. Results A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow‐up. During the follow‐up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow‐up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow‐up period was a 7% reduction, with no significant trend of change over time. Conclusion Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow‐up of large thyroid nodules without surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

et al. 2019

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“…Currently, there is no connection between OFEK and other non-Clalit HMOs. Nirel et al found that “at clinics in catchment areas of hospitals using OFEK extensively, OFEK reduced the number of imaging tests and, to a lesser extent, laboratory testing and improved several quality measures” [23]. …”

Section: The Response To the Need For Information Flow In Israelmentioning

confidence: 99%

Sustainable health information exchanges: the role of institutional factors

Frankel

Chinitz

Salzberg

et al. 2013

Isr J Health Policy Res

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The transfer of patient information between the domains of community and hospital influences the quality, continuity and cost of health care. To supply the need for information flow between community and hospital, computerized Health Information Exchange (HIE) systems have evolved. This paper examines the institutional forces that shape HIE development in Israel and in the United States.In Israel, the vertically integrated Clalit health services developed a different solution for HIE than was developed in the non-vertically integrated Maccabi and Meuhedet health funds. In the United States the fragmented nature of providers – outside of specific networks such as parts of the Kaiser Permanente and Veterans Administration system – have dictated a very different evolution of information flow between community and hospital. More broadly, we consider how institutional factors shape (and will shape) the development of HIEs in different contexts.This paper applies institutional analysis to explain the emergence of different patterns of development of HIE systems in each of the environments. The institutional analysis in this paper can be used to anticipate the future success or failure of incentives to promote digital information sharing at transition of care.

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Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

et al. 2020

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Objectives/Hypothesis Revision endoscopic dacryocystorhinostomy (END‐DCR) is the preferred approach for failed primary surgeries, yet quality data on long‐term outcomes are lacking. This study aimed to evaluate three aspects of revision END‐DCR: 5‐year success rates, patient satisfaction, and the primary surgical approach's possible impact on revision. Methods This retrospective study included all revision END‐DCRs conducted at Kaplan Medical Center between the years 2002 and 2015. For long‐term follow‐up analysis, two subgroups of first and second revision END‐DCRs with a minimum of documented 5‐year follow‐up after surgery were defined. Data were analyzed according to the primary surgical approach. Surgical success was defined by either anatomical (observed patent lacrimal flow) or functional (symptoms cessation) success. Patient satisfaction was measured by a questionnaire. Results After exclusions, a total of 45 eyes from 38 patients who underwent revision END‐DCR surgeries were included in the study. The yearly success rates from immediate to 5 years following the first revision were 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9% for the entire cohort, respectively. Immediate and 5‐year success rates following the second revision were 88.8% and 77.8%, respectively. Primary END‐DCR showed favorable 5‐year success rates and patient satisfaction over primary external dacryocystorhinostomy (EXT‐DCR) in both first and second revisions, but this did not reach significance. Conclusions Revision END‐DCR carries an excellent short‐term success rate, which decreases mainly throughout the first 2 years following surgery. Postoperative follow‐up should be maintained within this timeframe. Revision END‐DCR following either primary endoscopic or EXT‐DCR produces comparable surgical outcomes and patient‐reported satisfaction. Level of Evidence 3b Laryngoscope, 131:E682–E688, 2021

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The impact of an integrated hospital-community medical information system on quality of care and medical service utilisation in primary-care clinics

Cited by 14 publications

References 10 publications

Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

Sustainable health information exchanges: the role of institutional factors

Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

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