Methodological Evaluation of Studies
| Study | Funding | Population | Independent Variable | Dependent Variable | Other Methodological Issues |
|---|---|---|---|---|---|
| Gadd (2000) | None specified | Sampling method: non random, sequential Sample size: not justified Response rate: 82% | EHR was in the exam room for more than 6 months prior to data collection Unsure how many physicians used it or how they did | Survey for patient satisfaction attitudes, developed and validated Blinding of data collector: N/A Blinding of analyst: not specified | Possible variable experience with EHR usage inside the room Potential confounders considered in analysis: patient age, gender, self-rated computer sophistication or computer use |
| Gadd (2001) | None specified | Sampling method: nonrandom Sample size: not justified Response rate: 77% in pre- and in post- | Time (preimplementation and postimplementation of EHR) Unsure how many physicians used EHR or how they did | Physicians’ perception; instrument validated Blinding of data collector: N/A Blinding of analyst: not specified | No confounders were considered in the analysis Postintervention data collection over 18 months period |
| Garrison (2002) | HRSA grant | Sampling method: nonrandom for post-, random for pre- Sample size justified Clear eligibility criteria Comparison to a historical sample Response rate 64% in post- | Time (pre/post) Describes if physicians used EHR inside room | Questionnaire designed for this study, piloted, but no mention of validation Blinding of data collector or data analyst: not mentioned | Addressed respondent bias Analyzed if associations with patients’ perception of physicians’ computer skills and patients’ personal use of computer No adjustments for confounders mentioned |
| Hsu (2005) | Garfield memorial fund | Sampling method: nonrandom; PCP volunteers and their patients; convenience Sample size: not justified Eligibility criteria defined Patients’ response rate: 80% | Physicians familiar with the system prior to the intervention Training happened between data collection times in post (100% physicians attended) | Self-administered questionnaire, pre-tested; based on “Medical Outcomes Study” No mention of blinding in data collection or analysis | Confounders considered in analysis: age, gender, self-reported health status, race/ethnicity, annual household income, education, previously seen the PCP |
| Johnson (2005) | Multiple* | Sampling method: nonrandom in post- Eligibility defined Control: random selection, historical Sample size justified Response rate 92% (post) | Use of EHR assessed after the encounter by physicians | Questionnaire based on a tool developed by Wissow el al to assess satisfaction No mention of blinding of data collector or analyst | Confounders considered in analysis: Physician sex and year of training, possible within physician correlations |
| Joos (2006) | No funding | Sampling method: nonrandom, convenient Sample size not justified Response rate 66% (physicians) | EHR already in place before this survey done No direct assessment of use of EHR, but general questions (not after each encounter) | Survey built after qualitative section, tested for face validity No blinding for data collection or analysis | Confounders considered in the analysis: gender, computer skill, message basket use and years of practice (but not for the outcome of interest) |
| Rouf (2006) | HRSA | Eligibility specified Sampling method: nonrandom Sample size not justified Response rate 61% of attending and 38% of residents | EHR already in place | Questionnaires from Medical Outcomes Study–reviewed for face validity–and piloted No blinding | Confounders considered in the analysis: done but not specified which ones |
* Funding from Robert Wood Johnson Foundation, Agency for Healthcare Research and Quality, Maternal and Child Health Bureau, Health Resources and Services Administration-Department of Health and Human Services, National Center for Injury Prevention and Control.
EHR, electronic health record; HRSA, Health Resources and Services Administration; PCP, primary care physician.