Human Factors Intervention to Reduce Risk in Primary Care of the Elderly
Human Factors Intervention to Reduce Risk in Primary Care of the Elderly
Human factors engineering literature makes clear that appropriate, well-designed and
 well-timed information improves decision making and can reduce mental workload. Data from a
 previous study showed that appropriate, well-designed and well-timed information is not
 present in many primary care encounters with elderly patients. This puts primary care
 physicians at risk of higher mental workload and poor decision making which can affect the
 quality and safety of care delivered to patients. Elderly patients are at particular risk
 because they are more likely to have more comorbidities, medications, and cognitive
 impairments.

 Dr. Karsh and his research team will test an intervention to improve the performance of
 primary care physicians and, thus the safety of primary care of the elderly. The
 investigators will use a randomized experiment, with random assignment at the level of
 patient, to test and evaluate the intervention. The evaluation will involve 4 primary care
 clinics, with 4 primary care physicians per clinic. The investigators will collect data from
 768 patient visits pre-intervention and 1536 patient visits during the intervention.
 Intervention patients will be randomly assigned to the intervention or care as usual.

 The Intervention has two components:

 Pre-visit care coordination:

 -  5-7 days prior to a study patient's appointment with his/her doctor, the doctor's
 nurse/MA will call the study patient and collect pertinent clinical information about
 the patient using a data collection form the investigators call a Patient Overview
 Document or POD.

 -  The nurse/MA will ensure that any lab results, consultant reports, ER reports, imaging
 studies, etc., that will be needed by the physician are available to the doctor.

 Team Meeting:

 On the day of the patient's appointment and prior to the beginning of the clinic session, the
 nurse/MA will meet briefly with the doctor to jointly review the POD.

 Hypotheses:

 H1. Primary Care Physician (PCP): The intervention will increase situation awareness, reduce
 PCP mental workload, reduce PCP perceived likelihood of error, and improve PCP visit
 satisfaction. PCP efficiency, as measured by encounter problem density during a visit, will
 also improve.

 H2. Patient: The intervention will improve patients' perceptions of their visits on a variety
 of AHRQ CAHPS measures, such as physician knowledge of patient history.

 H3. Patient: The intervention will not impact the number or types of problems addressed
 during the visit.

 H4. Clinic: The intervention will not affect visit RVUs
Inclusion Criteria:

 -  Must be greater than or equal to 65 years of age

 -  Must be patients of participating physicians

 Exclusion Criteria:

 -  Cannot speak English

 -  Cannot hear well enough to respond to questions via the telephone or do not have a
 caregiver who can respond to questions on their behalf