Priorities Wizard: Multisite Web-Based Primary Care Clinical Decision Support Improved Chronic Care Outcomes with High Use Rates and High Clinician Satisfaction Rates.
Priorities Wizard: Multisite Web-Based Primary Care Clinical Decision Support Improved Chronic Care Outcomes with High Use Rates and High Clinician Satisfaction Rates.
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DOI：
10.5334/egems.284
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发表时间：
2019-04-03
期刊：
影响因子：
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通讯作者：
O'Connor, Patrick J
中科院分区：
文献类型：
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作者：
Sperl-Hillen, JoAnn M;Rossom, Rebecca C;O'Connor, Patrick J
简介：Priorities Wizard是一个与电子健康记录链接的、基于网络的临床决策支持（CDS）系统，在多个医疗保健系统研究网络（HCSRN）站点设计和实施，以支持高质量的门诊慢性病和预防性护理。CDS系统（a）识别可以从循证行动中获益的患者;（B）在护理点向患者和临床医生提供优先循证治疗方案;（c）促进推荐药物、转诊或程序的有效订购。CDS系统从电子健康记录（EHR）中提取相关数据，使用基于Web的临床决策支持算法处理数据，并在EHR屏幕上无缝地显示CDS输出，以供临床医生和患者使用。通过由HealthPartners Institute和HealthPartners慢性病护理创新中心以及HCSRN合作伙伴领导的一系列美国国立卫生研究院资助的项目，Priorities Wizard已经在群集随机试验中进行了评估，并扩展到包括20多个临床领域。随机试验表明，这种CDS系统显著改善了糖尿病患者的血糖和血压控制，降低无糖尿病的高CV风险成人的10年心血管（CV）风险，改善牙科患者的吸烟管理，改善青少年的高血压识别和管理。CDS输出被用于71- 77%的目标访问，85- 98%的临床医生满意的CDS系统，94%的报告，他们会推荐给colleages.CONCLUSIONS：最近开发的EHR链接，基于Web的CDS系统有显着改善慢性病护理的结果，并有很高的使用率和初级保健临床医生的满意度。
INTRODUCTION: Priorities Wizard is an electronic health record-linked, web-based clinical decision support (CDS) system designed and implemented at multiple Health Care Systems Research Network (HCSRN) sites to support high quality outpatient chronic disease and preventive care. The CDS system (a) identifies patients who could substantially benefit from evidence-based actions; (b) presents prioritized evidence-based treatment options to both patient and clinician at the point of care; and (c) facilitates efficient ordering of recommended medications, referrals or procedures.METHODS: The CDS system extracts relevant data from electronic health records (EHRs), processes the data using Web-based clinical decision support algorithms, and displays the CDS output seamlessly on the EHR screen for use by the clinician and patient. Through a series of National Institutes of Health-funded projects led by HealthPartners Institute and the HealthPartners Center for Chronic Care Innovation and HCSRN partners, Priorities Wizard has been evaluated in cluster-randomized trials and expanded to include over 20 clinical domains.RESULTS: Cluster-randomized trials show that this CDS system significantly improved glucose and blood pressure control in diabetes patients, reduced 10-year cardiovascular (CV) risk in high-CV risk adults without diabetes, improved management of smoking in dental patients, and improved high blood pressure identification and management in adolescents. CDS output was used at 71-77 percent of targeted visits, 85-98 percent of clinicians were satisfied with the CDS system, and 94 percent reported they would recommend it to colleagues.CONCLUSIONS: Recently developed EHR-linked, Web-based CDS systems have significantly improved chronic disease care outcomes and have high use rates and primary care clinician satisfaction.