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Nurses can facilitate quality improvement in primary care practices with electronic medical records

Nurses can play an important role in facilitating quality improvement in primary care practices with electronic medical record (EMR) systems, concludes a new study. The Practice Partners Research Network (PPRNet), a primary care practice-based research network, disseminated a five-pronged improvement model to its practices through quarterly performance reports for each quality of care indicator, practice site visits, and annual network meetings. The goal of the Quality Indicator (QI) model was to prioritize performance, involve all staff, redesign delivery systems, activate the patient, and use EMR tools.

The PPRNet practices boosted the involvement of staff members to determine approaches to improvement and focused on specific quality indicators each quarter. They also made efforts to redesign the delivery system. For example, they reviewed office processes to streamline and reduce redundancy or inefficiency, established written protocols to guide chronic disease management, and formed care management teams of providers and nurses to help patients with chronic illness. They also made more use of EMR tools. For example, they used EMR ticklers and recall systems to remind patients of screening services needed. Except for one patient education tool, patient activation strategies were the least commonly adopted improvement strategies.

Practice nursing staff assumed many new roles to enhance communication between patients and providers. Using templates within the EMR system, they reviewed what health maintenance screening tests were due and reconciled medication lists with patients. They increased the accuracy of patients' medication lists. Nurses also alerted providers to elevated blood pressures and other clinical parameters not at goal, and prompted them to administer or schedule interventions.

The study was supported by the Agency for Healthcare Research and Quality (HS13716).

See "Strategies to accelerate translation of research into primary care within practices using electronic medical records," by Lynne S. Nemeth, Ph.D., R.N., Andrea M. Wessell, Pharm.D., Ruth G. Jenkins, Ph.D., and others, in the October-December 2007 Journal of Nursing Care Quality 22(4), pp. 343-349.

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