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| Name | Class |
|---|---|
| Norwegian University of Science and Technology | OTHER |
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The case history of patients with complex and long-term needs is often stored in fragments across many different care providers, each with a separate electronic health record. Even when the notes are stored in the same organization, the large volume of information makes it difficult for practitioners to grasp the full overview of the patient's situation.
The DigiTeam tool, combines information management features to present notes from across the care pathway from the three main providers: General Practice, Health and Social care Services, and Secondary care. It also includes summaries of the patient's concerns, conditions, and treatment plan. It provides links to the source documents that are the basis for the summaries.
The overarching aim is to examine the effect of physicians' use of the DigiTeam for three patient cases derived from real-world pseudonymized notes, on the quality of the physcians' ensuing case summary and treatment plan. In the comparator arms, physicians use usual care tools, i.e. only one or three sources of notes and no information management features.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 01 Usual care with clinical notes from one provider | Active Comparator | Access to all clinical notes available to the provider in the patient's case. The provider is General practice in two patient cases, and hospital in one patient case. |
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| 02 Clinical notes from several providers | Active Comparator | Access to all clinical notes across three providers: General practitioner, Social services and Specialist care. |
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| 03 - DigiTeam - Summaries of and clinical notes from several providers | Experimental | Access to all clinical notes across three providers: General practitioner, Social services and Specialist care, like in arm 02. In addition, access to information management features, such as summaries of patient's priorities, and clinical summaries of key health problems, including links to source documents. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 03 - Summaries of and clinical notes from several providers | Other | Access to all clinical notes across three providers: General practitioner, Social services and Specialist care, like in arm 02. In addition, access to information management features, such as summaries of patient's priorities, and clinical summaries of key health problems, including links to source documents. |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of patient summary and follow-up plan | The primary outcome is the quality of the patient summary and follow-up plan Participants are asked to create a summary as preparation for a care planning meeting with colleagues, using the information available in the digital tool to write 1) a Comprehensive summary of the patient's situation and 2. A care plan. Quality of summaries and care plans will be measured by Microsoft Copilot. An expert group of three clinicians will create gold-standard summaries. These will be converted into a list of clear, mutually exclusive items using standardized rules. Copilot will be prompted to identify whether each item is present in participant responses. The item list will be validated by comparing scoring consistency (Kappa statistics) between researchers and Copilot, aiming for ≥0.7 agreement with researchers and ≥0.9 between Copilot runs. Final scores will reflect the number of items included per response. | Immediately after completing the the task for each patient |
| Measure | Description | Time Frame |
|---|---|---|
| Time spent completeing the patient case overviews and follow-up plans | Time from start of case to delivery of answer as measured by participant reported start and stop time. | Immediately after completing the the task for each patient |
| System Usability Scale |
| Measure | Description | Time Frame |
|---|---|---|
| Technical problems | To describe the experience with the digital solution used, the following question will be used Did you have any technical problems in completing this task? No, none at all Some, but it was minimal Yes, quite extensive. | Immediately after completing the the task for each patient |
| Experience with the type of patients |
Inclusion Criteria:
If the recruitment is difficult, medical students and other physicians may be included.
To recruit participants, the trial will be announced through known networks, social media, the researchers' network, and general announcements.
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gro KR Berntsen, Prof | Norwegian Center for E-health Research | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University hospital North Norway | Tromsø | Troms | 9037 | Norway |
Anonymized questionnaire data
At publication of planned papers from the RCT
Contact authors.
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| ID | Term |
|---|---|
| D000071069 | Multiple Chronic Conditions |
| ID | Term |
|---|---|
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D063127 | Secondary Care |
| ID | Term |
|---|---|
| D012017 | Referral and Consultation |
| D011364 | Professional Practice |
| D009934 | Organization and Administration |
| D006298 | Health Services Administration |
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Participants are block randomized to balance the three arms (Usual care, 3 sources, Summaries). The sizes of the blocks are set by a trial service office, and not known to those involved in the trial.
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The Outcome Assessor of the primary outcome is a large language model, which assesses the answers provided by the participants without any information about group allocation.
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| 01 - Clinical notes from one provider | Other | Access to all clinical notes available to the provider in the patient's case. The provider is General practice in two patient cases, and hospital in one patient case. |
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| 02 - Access to notes from primary and secondary care | Other | Access to all clinical notes across three providers: General practitioner, Social services and Specialist care. |
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The usability of the intervention to do the work needed for each patient will be measured with the System Usability Scale which contains ten items scored from one (strongly disagree) to five (strongly agree) that are transformed to a 0 to 100 scale and translated into a curved grading scale from A-F |
| Immediately after completing the the task for each patient |
| Information support for solving tasks | To compare how the different interventions helped to solve the task described under primary outcome, the following questions will be asked: On a scale of 1 to 5 (1 Poor 2 Fair 3 Good 4 Very good 5 Excellent), how did the information you had access to support you to find information about
| Immediately after completing the the task for each patient |
| Experience with conducting the task | To compare the experience with the digital tool used to conduct the tasks, the following questions will be used: On a scale of 1 to 5 (1 Poor 2 Fair 3 Good 4 Very good 5 Excellent)
Would you recommend the tool to colleagues? (Yes Unsure No) | Immediately after completing the the task for each patient |
To describe whether the participants had experiences with the types of patients, the following question will be asked: How often do you work with patients who have as complex and long-term needs as this patient? (Weekly, Monthly, Semi-annually or less frequently) |
| Immediately after completing the the task for each patient |
| Time spent on various activities | To describe the time used on various activities in the digital tool, the following variables will be automatically recorded in the tool:
| Immediately after completing the the task for each patient |
| D003695 | Delivery of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |