The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India.
The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India.
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DOI：
10.1186/s12884-021-03710-y
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发表时间：
2021-04-07
影响因子：
3.1
通讯作者：
Sood B
中科院分区：
文献类型：
--
作者：
Usmanova G;Lalchandani K;Srivastava A;Joshi CS;Bhatt DC;Bairagi AK;Jain Y;Afzal M;Dhoundiyal R;Benawri J;Chaudhary T;Mishra A;Wadhwa R;Sridhar P;Bahl N;Gaikwad P;Sood B
计算机化的临床决策支持（CDSS）-数字信息系统，旨在改善临床决策的提供者-是一个有前途的工具，提高护理质量。本研究旨在了解ASMAN应用程序的使用情况（定义为电子病例表的完整性），CDSS在改善关键临床实践依从性和交付结局方面的作用。我们对从中央邦和拉贾斯坦邦两个邦各四个地区的81个公共设施收集的项目数据（政府数据）进行了二次分析。分析了2017年8月至10月（基线）期间收集的数据和2019年12月至2020年3月（最新）期间收集的数据。数据来源包括：数字化产房登记册、病例表、转诊和出院总结表、观察清单和并发症格式。进行描述性、单变量、多变量和间断时间序列回归分析。产后期间（40.5%）和每月超过300次分娩的机构（20.9%）电子病例表的完整性较低。在多变量逻辑回归分析中，技术的引入在遵守关键临床实践方面取得了显着改善。我们已经观察到新鲜死产率和窒息率的下降，但这些结果在中断时间序列分析中没有统计学意义。然而，我们的分析表明，产妇并发症的识别在方案实施期间有所增加，同时转诊减少。我们的研究表明，CDSS有潜力提高产时护理质量和分娩结局。未来的研究需要严格的研究设计，以了解技术在提高孕产妇护理质量方面的影响。在线版本包含补充材料，可通过10.1186/s12884-021-03710-y获取。
Computerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes. We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August –October 2017 (baseline) and the data collected between December 2019 – March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted. The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased. Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care. The online version contains supplementary material available at 10.1186/s12884-021-03710-y.
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影响因子：
168.9
作者：
Kassebaum, N. J.;Bertozzi-Villa, A.;Coggeshall, M. S.
通讯作者：
Coggeshall, M. S.
影响因子：
158.5
作者：
Semrau, Katherine E. A.;Hirschhorn, Lisa R.;Gawande, Atul A.
通讯作者：
Gawande, Atul A.
影响因子：
2.9
作者：
Horner, V.;Rautenbach, P.;Kwinda, H.
通讯作者：
Kwinda, H.
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168.9
作者：
Lim, Stephen S.;Dandona, Lalit;Gakidou, Emmanuela
通讯作者：
Gakidou, Emmanuela
影响因子：
105.7
作者：
Kawamoto, K;Houlihan, CA;Lobach, DF
通讯作者：
Lobach, DF