The aim of this 3-year project is to implement and evaluate and enhanced COSTAR (Computer Stored Ambulatory Record) system to facilitate integration of acute and long-term health care of the elderly. Encounter forms with a structural vocabulary will be used for recording problems, interventions, functional status and outcomes. Long Term Care Plan will be provided to facilitate clinical case management. Automated protocols and computer-printed reminders for quality assurance in monitoring patients, in documentation and in resource utilization will be implemented. A query language will be provided for health professionals to search the structured data base. The """"""""Classification Scheme for Client Problems in Community Health Nursing"""""""" will be used to describe patient problems assessed by nurses and social workers. The automated system will be implemented in the newly formed Long Term Care Management Unit of the Massachussetts General Hospital and in three satellite neighborhood health centers where patients followed by the Unit will receive primary care. These patients will receive intensive monitoring of health status and coordination of community-based health care; their records will be kept on the automated system. Providers in the neighborhood health centers will use the automated system for these patients, and will use their conventional record-keeping system for all other patients. At the end of the project period, the automated system will be evaluated. Providers will be asked to evaluate the automated system in comparison with the manual one. Record audit will be done to compare """"""""completeness"""""""" of documentation in both the automated and manual systems. The effect of the computer-based reminders in stimulating adherence to the quality assurance protocols will be assessed. The ability of the Medical Query Language to eliminate the need for programmer assistance in conducting analyses of the clinical data base will be evaluated. The clinical data base will be analyzed to determine the frequency with which the """"""""Classification Scheme for Client Problems in Community Health Nursing"""""""" was able to be used to describe patient problems. It is anticipated that this enhanced COSTAR system will be transferable to the public health/community health setting, where there is an acute need for an integrated automated system with a nursing-oriented clinical component that stores structured data amenable to analysis and research.
