Computer-based documentation: effects on parent-provider communication during pediatric health maintenance encounters.

Full Abstract

OBJECTIVE:
The goal was to investigate the impact of a computer-based documentation tool on parent-health care provider communication during a pediatric health maintenance encounter.

METHODS:
We used a quasiexperimental study design to compare communication dynamics between clinicians and parents/children in health maintenance visits before and after implementation of the ClicTate system. Before ClicTate use, paper forms were used to create visit notes. The children examined were </=18 months of age. All encounters were audiotaped or videotaped. A team of research assistants blinded to group assignment reviewed the audio portion of each encounter. Data from all recordings were analyzed, by using the Roter Interaction Analysis System, for differences in the open/closed question ratio, the extent of information provided by parents and providers, and other aspects of spoken and nonverbal communication (videotaped encounters).

RESULTS:
Computer-based documentation visits were slightly longer than control visits (32 vs 27 minutes). With controlling for visit length, the amounts of conversation were similar during control and computer-based documentation visits. Computer-based documentation visits were associated with a greater proportion of open-ended questions (28% vs 21%), more use of partnership strategies, greater proportions of social and positive talk, and a more patient-centered interaction style but fewer orienting and transition phrases.

CONCLUSIONS:
The introduction of ClicTate into the health maintenance encounter positively affected several aspects of parent-clinician communication in a pediatric clinic setting. These results support the integration of computer-based documentation into primary care pediatric visits.

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Author information

Author/s: Johnson, Kevin B (KB); Serwint, Janet R (JR); Fagan, Lawrence A (LA); Thompson, Richard E (RE); Wilson, Modena E H (ME); Roter, Debra (D);

Affiliation: Department of Pediatrics, Vanderbilt University Medical Center, 2209 Garland Ave, Nashville, TN 37232, USA. kevin.johnson(-atsign-)vanderbilt.edu

Grants: MCJ-240638 (Agency:United States PHS) ; R03 HS10363-01 (Agency:United States AHRQ) ; R49/CCR302486 (Agency:United States PHS)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.

Journal: Pediatrics (Pediatrics), published in United States. (Language: eng)

Reference: 2008-Sep; vol 122 (issue 3) : pp 590-8

Dates: Created 2008/09/02; Completed 2008/09/16;

PMID: 18762530, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent
Child
Child, Preschool
Communication
Documentation - methods
Female
Health Maintenance Organizations - statistics & numerical data

Health Personnel - ethics
Humans
Infant
Infant, Newborn
Male
Medical Records Systems, Computerized - standards
Physician-Patient Relations - ethics

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