Online practice guidelines: issues, obstacles, and future prospects.
Online practice guidelines: issues, obstacles, and future prospects.
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在线实践指南：问题、障碍和未来前景。
DOI：
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
R. Zielstorff
中科院分区：
文献类型：
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作者：
R. Zielstorff
“指南运动”的形成是为了减少实践中的可变性，控制成本，改善患者护理结果。然而，对实践和结果的总体影响令人失望。证据表明，促进认识和遵守最佳做法的最有效方法是在护理点提供计算机生成的提醒。本文回顾了从制定指南到将其纳入实践以及随后评估其对实践和结果的影响的五个沿着步骤。在每一个步骤中出现的问题和障碍，从一个步骤到下一个步骤进行了说明。最后，强调了有助于克服障碍的发展。这些包括1）使用数据挖掘更快速地获取知识，2）使用模糊逻辑更好地适应临床算法中的不精确知识，3）开发用于指南表示和执行的可共享模型，以及4）支持护理点决策的临床稳健信息系统的更广泛可用性。
The "guidelines movement" was formed to reduce variability in practice, control costs, and improve patient care outcomes. Yet the overall impact on practice and outcomes has been disappointing. Evidence demonstrates that the most effective method of stimulating awareness of and compliance with best practices is computer-generated reminders provided at the point of care. This paper reviews five steps along the path from the development of a guideline to its integration into practice and the subsequent evaluation of its impact on practice and outcomes. Issues arising at each step and obstacles to moving from one step to the next are described. Last, developments that could help overcome the obstacles are highlighted. These include 1) more rapid knowledge acquisition using data mining, 2) better accommodation to imprecise knowledge in clinical algorithms using fuzzy logic, 3) development of a shareable model for guideline representation and execution, and 4) more widespread availability of clinically robust information systems that support decision-making at the point of care.