title: Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial.
abstract: BACKGROUND
  Electronic information exchange is believed to improve efficiency and reduce resource utilization. We developed a Web-based standardized communication system (SCS) that enables family physicians to receive detailed reports of their patients' care in the emergency department. We sought to determine the impact of the SCS on measures of resource utilization in the emergency department and family physician offices.
  
  
  METHODS
  We used an open 4-period crossover cluster-randomized controlled design. During 2 separate 10-week intervention phases, family physicians received detailed reports of their patients' emergency department visits over the Internet, and in the alternating control phases they received a 1-page copy of the emergency department notes by mail. The primary outcome was the number of repeat visits to the emergency department within 14 days of the initial visit. Secondary outcomes included duplication of test and specialty consultation requests by the emergency and family physician. Outcomes were measured using the hospital database and questionnaires sent to the family physicians.
  
  
  RESULTS
  A total of 2022 patient visits to the emergency department from 23 practices were used in the study. Use of the SCS failed to reduce the number of repeat visits to the emergency department within 14 days (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.8-1.51) and 28 days (OR 1.01, 95% CI 0.8-1.27). There was no significant duplication of requests for diagnostic tests between the emergency and family physician during the intervention and control phases (24 v. 22, p = 0.93), but there was significantly greater duplication in specialty consultation requests in the intervention phase than in the control phase (20 v. 8, p = 0.049).
  
  
  CONCLUSIONS
  An electronic link between emergency and family physicians did not result in a significant reduction in resource utilization at either service point. Investments in improved electronic information exchange between emergency departments and family physician offices may not be substantiated by a reduction in resource utilization.
authors.affiliation: Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Qué. eddy.lang@mcgill.ca
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.forename: Marc
authors.initials: M
authors.lastname: Afilalo
authors.forename: Alain C
authors.initials: AC
authors.lastname: Vandal
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Boivin
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Xue
authors.forename: Antoinette
authors.initials: A
authors.lastname: Colacone
authors.forename: Ruth
authors.initials: R
authors.lastname: Léger
authors.forename: Ian
authors.initials: I
authors.lastname: Shrier
authors.forename: Stephen
authors.initials: S
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005194:Family Practice; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007255:Information Services; D020407:Internet; D007400:Interprofessional Relations; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009819:Office Visits