The present study explored the effect of use of an online knowledge base on patient experiences and health care quality in primary health care centers (PHCC) in Sweden.
The possible effects of knowledge base (KB) use on patient care outcomes in quality registries (QR) are scarcely reported. To the best of our knowledge, the present study is the first to examine such possible associations.
Medicine is a knowledge-intense area with a continuous need to keep up-to-date with the latest evidence and to apply it to everyday patient care. Evidence-based medicine (EBM) may be a tool for connecting the current best evidence with clinical practice (1, 2). In order to apply EBM in practice, knowledge is needed at the point of care (3). Online KBs may provide for these needs (4). By capturing EBM health care outcomes in medical QRs, real-world evidence can be used to improve the quality of health care (5, 6).
EBM is “the use of the best available evidence for decision-making related to the treatment of a specific patient by applying results of systematic, reproducible, unbiased research in clinical practice” (7, 8). EBM used at the point of care has been reported to mitigate risk, effectively improve patient care outcomes, and reduce cognitive overload which can lead to medical errors (1, 2, 7, 9). A crucial step in EBM is to translate the evidence and apply the results in clinical practice. Knowledge does not necessarily change practice and mere dissemination of scientific evidence may be insufficient to change professional behavior (10).
Online KBs have been shown to increase the application of EBM in clinical practice (11–13).
In this study, we used Lobach’s definition of a KB: “Electronic (computer-based) resources comprising distilled (synthesized) or curated information that allows clinicians to select content
germane to a specific patient to facilitate medical decision making” (14). The use of KBs is associated with a positive impact on clinician behavior and patient outcomes, and evidence suggests that use of KBs may be associated with improved knowledge and patient outcomes (12, 15, 16).
The KB explored in this study was Medibas, a web-based knowledge source for general practitioners (GPs) in Sweden providing access to evidence-based medical knowledge in everyday clinical life (17). Medibas’ editorial staff of GPs and its network of over 200 specialist doctors gather and summarize new scientific studies, reviews, national guidelines and recommendations and incorporate these into the KB.
A national QR contains individual-based information on diagnoses and medical outcome measures in health care. QRs can identify factors that may impact on patient survival (18).
There are over a hundred national QRs in Sweden (19). QRs have the potential to collect
real-world data, i.e. data collected outside of randomized controlled trials showing the unbiased results of real-life daily clinical practice. Patient experience data can be collected as patient reported outcome measures – questionnaires to record their experience of health care services. This can provide an understanding of how health care interventions impact on patients’ quality of life and allows for comparisons of health care providers’ performances (20). Real-world data can also be collected in QRs as objective outcome data, e.g. laboratory results or findings in physical examinations.
There is a lack of knowledge on whether the use of KBs reflects the patient outcomes data in nationwide QRs and whether burden of care, measured in Sweden as a care need index (CNI),
influences the register outcomes in any way (21). The aim of this study was to explore the effect of use of an online KB on patient experiences and health care quality.