Computerized decision support based on a clinical practice guideline improves compliance with care standards
Computerized decision support based on a clinical practice guideline improves compliance with care standards
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DOI：
10.1016/s0002-9343(96)00382-8
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发表时间：
1997-01-01
影响因子：
5.9
通讯作者：
Hammond, WE
中科院分区：
文献类型：
--
作者：
Lobach, DF;Hammond, WE
目得：临床指南旨在帮助管理特定疾病;然而，这些指南在提供护理时往往被忽视。本研究的目的是确定临床医生是否会增加对临床实践指南的使用，以响应在患者就诊时具有基于实践指南的决策支持系统，该决策支持系统使用来自患者电子病历的数据为个体患者生成定制的管理协议。在一项为期6个月的初级保健诊所对照试验中，58名初级保健临床医生随机接受计算机生成的指南建议的特殊就诊表或标准就诊表。计算机生成的建议对临床医生行为的影响被衡量为与指南建议的依从率。从30名临床医生的数据进行了分析，从28名临床医生的数据被排除在外，因为这些临床医生不符合预定义的标准，最低限度暴露于糖尿病患者care.RESULTS：可用性的决策支持系统产生的患者管理建议，导致在临床医生的依从性与糖尿病护理指南的两倍增加（P = 0.01）。接受建议的组的中位依从性为32.0%，对照组为15.6%。结论：基于临床实践指南的决策支持是一种有效的工具，用于协助临床医生管理糖尿病患者。这个决策支持系统提供了一个模型，临床实践指南如何可以通过计算机集成到护理过程中，以帮助临床医生管理特定的疾病，通过帮助他们遵守护理标准。使用基于临床实践指南的决策支持系统最终可以提高医疗质量。(C)1997年，Excerpta Medica，Inc.
PURPOSE: Clinical guidelines are designed to assist in the management of specific diseases; however, these guidelines are often neglected in the delivery of care. The purpose of this study was to determine whether clinician use of a clinical practice guideline would increase in response to having, at the patient visit, a decision support system based on a practice guideline that generates a customized management protocol for the individual patient using data from the patient's electronic medical record.SUBJECTS AND METHODS: In a 6-month controlled trial at a primary care clinic, 58 primary care clinicians were randomized to receive either a special encounter form with the computer-generated guideline recommendations or a standard encounter form. The effect of computer-generated advice on clinician behavior was measured as rate of compliance with guideline recommendations. Data from 30 clinicians were analyzed; data from 28 clinicians were excluded because these clinicians did not meet predefined criteria for minimum exposure to diabetic patient care.RESULTS: Availability of patient management recommendations generated by the decision support system resulted in a two-fold increase in clinician compliance with care guidelines for diabetes mellitus (P = 0.01). Median compliance for the group receiving the recommendations was 32.0% versus 15.6% for the control group.CONCLUSION: Decision support based on a clinical practice guideline is an effective tool for assisting clinicians in the management of diabetic patients. This decision support system provides a model for how a clinical practice guideline can be integrated into the care process by computer to assist clinicians in managing a specific disease through helping them comply with care standards. Use of decision support systems based on clinical practice guidelines could ultimately improve the quality of medical care. (C) 1997 by Excerpta Medica, Inc.