Improving ambulatory prescribing safety with a handheld decision support system: A randomized controlled trail
Improving ambulatory prescribing safety with a handheld decision support system: A randomized controlled trail
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DOI：
10.1197/jamia.m1961
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发表时间：
2006-03-01
影响因子：
6.4
通讯作者：
Maisiak, RS
中科院分区：
文献类型：
--
作者：
Berner, ES;Houston, TK;Maisiak, RS
目的：为了评估的有效性，个人数字助理（PDA）为基础的临床决策支持系统（CDSS）的非甾体抗炎药（NSAID）处方的安全性在门诊setting.Design：该设计是一个随机对照试验，在一所大学为基础的居民诊所进行。内科住院医师收到了基于PDA的CDSS套件。对于干预居民，CDSS包括NSAID相关胃肠道风险评估和治疗建议的预测规则。未经通知的标准化患者（SP）接受培训，以描述向研究医生介绍的肌肉骨骼症状。安全性结局根据给SP的处方进行评估。每一个处方都由一个对参与者、干预组分配、基线或随访状态不知情的临床医生委员会进行审查。主要结果测量是干预组与对照组NSAIDs不安全处方的差异变化。结果：在基线时，两组每名医生不安全处方的平均病例比例相似（0.27 vs. 0.29，p > 0.05）。控制基线表现，干预参与者在接受CDSS后比对照组更安全地开药（0.23 vs. 0.45 [F = 4.24，p < 0.05]）。与CDSS，干预参与者记录更完整的评估患者胃肠道风险NSAIDs.Conclusion：参与者提供了一个基于PDA的CDSS的NSAID处方作出更少的不安全的治疗决定比没有CDSS的参与者。
Objective: To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system (CDSS) on nonsteroidal anti-inflammatory drug (NSAID) prescribing safety in the outpatient setting.Design: The design was a randomized, controlled trial conducted in a university-based resident clinic. Internal medicine residents received a PDA-based CDSS suite. For intervention residents, the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations. Unannounced standardized patients (SPs) trained to portray musculoskeletal symptoms presented to study physicians. Safety outcomes were assessed from the prescriptions given to the SPs. Each prescription was reviewed by a committee of clinicians blinded to participant, intervention group assignment, and baseline or follow-up status.Measurements: Prescriptions were judged as safe or unsafe. The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group.Results: At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p > 0.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS (0.23 vs. 0.45 [F = 4.24, p < 0.05]). With the CDSS, intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs.Conclusion: Participants provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS.