Clinical Decision Support Intervention for Rib Fracture Treatment.
Clinical Decision Support Intervention for Rib Fracture Treatment.
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DOI：
10.1016/j.jamcollsurg.2020.04.023
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发表时间：
2020-08
影响因子：
5.2
通讯作者：
Tignanelli CJ
中科院分区：
文献类型：
--
作者：
Macheel C;Reicks P;Sybrant C;Evans C;Farhat J;West MA;Tignanelli CJ
肋骨骨折与严重的发病率和死亡率有关。尽管发布了管理指南和国家结果基准，但在循证(EB)遵守和结果方面存在重大差异。临床决策支持干预(CDSI)系统允许快速订购捆绑的针对疾病的EB治疗。我们在我们的机构开发了EB肋骨骨折方案和CDSI。本研究的目的是使用该CDSI评估实施情况和临床结果。2018年7月制定、传播和实施了肋骨骨折护理CDSI。使用普罗科特框架对执行成果进行了评估。每月通过运行图跟踪依从性，并使用统一技术接受和使用理论问卷对接受度进行7分Likert量表评估。使用倾向性评分匹配来比较实施前(2016年1月1日至2016年12月31日)和实施后(2018年9月1日至2019年4月30日)队列中的住院发病率和死亡率。共有197名患者符合接受干预的条件。提供商CDSI遵从性在1个月时为83%，7个月后达到100%。使用技术接受和使用的统一理论接受CDSI的平均Likert得分高于6(范围6.1到6.8，SD 0.5到1.5)，表明接受程度很高。与倾向匹配的受试者相比，实施后住院时间显著缩短(发生率比0.80；95%可信区间0.66至0.98；p=0.03)。CDSI的开发和使用改善了提供者提供的EB实践，并与减少住院时间有关。
Rib fractures are associated with significant morbidity and mortality. Despite the publication of management guidelines and national outcomes benchmarking, there is significant variation in evidence-based (EB) adherence and outcomes. Systems for clinical decision support intervention (CDSI) allow rapid ordering of bundled disease-specific EB treatments. We developed an EB rib fracture protocol and CDSI at our institution. The purpose of the current study was to evaluate implementation and clinical outcomes using this CDSI. A rib fracture care CDSI was developed, disseminated, and implemented in July 2018. Implementation outcomes were evaluated using the Proctor framework. Adherence was tracked monthly via run charts and acceptance was evaluated on a 7-point Likert scale using the Unified Theory of Acceptance and Use of Technology questionnaire. Propensity score matching was used to compare in-hospital morbidity and mortality in pre-implementation (January 1, 2016 through December 31, 2016) vs post-implementation (September 1, 2018 through April 30, 2019) cohorts. A total of 197 patients were eligible for the intervention. Provider CDSI adherence was 83% at 1 month and reached 100% after 7 months. Acceptance of CDSI using the Unified Theory of Acceptance and Use of Technology had a mean Likert score higher than 6 (range 6.1 to 6.8, SD 0.5 to 1.5), indicating high acceptance. A significant reduction in hospital length of stay was found post implementation (incident rate ratio 0.80; 95% CI, 0.66 to 0.98; p = 0.03) comparing propensity-matched subjects. The development and use of a CDSI resulted in improved provider delivery of EB practice and was associated with reduced hospital length of stay.
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
3.4
作者：
Brasel, Karen J.;Moore, Ernest E.;Biffl, Walter L.
通讯作者：
Biffl, Walter L.
影响因子：
2
作者：
Witt, Cordelie E;Bulger, Eileen M
通讯作者：
Bulger, Eileen M
DOI：
10.1007/s10488-008-0197-4
发表时间：
2009-01
影响因子：
2.6
作者：
Proctor, Enola K.;Landsverk, John;Aarons, Gregory;Chambers, David;Glisson, Charles;Mittman, Brian
通讯作者：
Mittman, Brian
DOI：
10.1186/s13012-017-0644-2
发表时间：
2017-09-15
期刊：
Implementation science : IS
影响因子：
--
作者：
Liberati EG;Ruggiero F;Galuppo L;Gorli M;González-Lorenzo M;Maraldi M;Ruggieri P;Polo Friz H;Scaratti G;Kwag KH;Vespignani R;Moja L
通讯作者：
Moja L