title: Behind-the-scenes of patient-centered care: content analysis of electronic messaging among primary care clinic providers and staff.
abstract: BACKGROUND
  Transitions to patient-centered health care, the increasing complexity of care, and growth in self-management have all increased the frequency and intensity of clinical services provided outside office settings and between visits. Understanding how electronic messaging, which is often used to coordinate care, affects care is crucial. A taxonomy for codifying clinical text messages into standardized categories could facilitate content analysis of work performed or enhanced via electronic messaging.
  
  
  OBJECTIVE
  To codify electronic messages exchanged among the primary care providers and the staff managing diabetes patients at an academic medical center.
  
  
  METHODS
  Retrospective analysis of 27,061 electronic messages exchanged among 578 providers and staff caring for a cohort of 639 adult primary care patients with diabetes between April 1, 2003 and October 31, 2003.
  
  
  METHODS
  Providers and staff using locally developed electronic messaging in an academic medical center's adult primary care clinic.
  
  
  METHODS
  Raw data included clinical text message content, message ID, thread ID, and user ID. Derived measures included user job classification, 35 flags codifying message content, and a taxonomy grouping the flags.
  
  
  RESULTS
  Messages contained diverse content: communications with patients, families, and other providers (47.2%), diagnoses (25.4%), documentation (33%), logistics and support functions (29.6%), medications (32.9%), and treatments (28.9%). All messages could be classified; 59.5% of messages addressed 2 or more content areas.
  
  
  CONCLUSIONS
  Systematic content analysis of provider and staff electronic messages yields specific insight regarding clinical and administrative work carried out via electronic messaging.
authors.affiliation: Department of General Internal Medicine, Vanderbilt University School of Medicine, Nashville Tennessee, USA. stiles@vanderbilt.edu
authors.forename: Renée A
authors.initials: RA
authors.lastname: Stiles
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Deppen
authors.forename: M Kathleen
authors.initials: MK
authors.lastname: Figaro
authors.forename: William M
authors.initials: WM
authors.lastname: Gregg
authors.forename: Jim N
authors.initials: JN
authors.lastname: Jirjis
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
authors.forename: Philip E
authors.initials: PE
authors.lastname: Johnston
authors.forename: Randolph A
authors.initials: RA
authors.lastname: Miller
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
mesh_terms: D000046:Academic Medical Centers; D034742:Electronic Mail; D006282:Health Personnel; D006801:Humans; D007400:Interprofessional Relations; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*