Computerized Clinical Decision Support During Medication Ordering for Long-term Care Residents with Renal Insufficiency
Computerized Clinical Decision Support During Medication Ordering for Long-term Care Residents with Renal Insufficiency
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DOI：
10.1197/jamia.m2981
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发表时间：
2009-07-01
影响因子：
6.4
通讯作者：
Gurwitz, Jerry H.
中科院分区：
文献类型：
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作者：
Field, Terry S.;Rochon, Paula;Gurwitz, Jerry H.
目的：确定实时提供针对患者的建议的计算机化临床决策支持系统是否可以提高肾功能不全的长期护理居民的处方质量。设计：在大型长期护理机构的长期住院病房内进行随机试验。随机化是按单元类型进行的。与肾功能不全居民处方药物相关的警报向干预单元的处方医生显示，并在控制单元中隐藏但进行跟踪。测量：在警报类别内比较干预单元和控制单元之间适当的最终药物订单的比例：（1）推荐的药物剂量； (2) 推荐的给药频率； (3) 避免使用该药物的建议； (4)信息缺失警告。结果：干预组和控制组的警报率几乎相等：干预组每千住日2.5次，对照组2.4次。对于其余警报类别，干预单元和控制单元之间最终药物订单适当的剂量警报比例相似（相对风险 0.95，95% 置信区间 0.83，11），干预单元中最终药物订单适当的比例显着较高：最大频率的相对风险 2.4（1.4，4.4）； 2.6 应避免使用的药物（1.4、5.0）； 1.8 用于获取缺失信息的警报（1.1、3.4）。总体而言，在干预单位中，最终药物处方的适当性明显更高 - 相对风险 1.2（1.0，1.4）。 结论：为医生为患有肾功能不全的长期护理居民开药提供临床决策支持，可以提高处方决策的质量。
Objective: To determine whether a computerized clinical decision support system providing patient-specific recommendations in real-time improves the quality of prescribing for long-term care residents with renal insufficiency.Design: Randomized trial within the long-stay units of a large long-term care facility. Randomization was within blocks by unit type. Alerts related to medication prescribing for residents with renal insufficiency were displayed to prescribers in the intervention units and hidden but tracked in control units.Measurement: The proportions of final drug orders that were appropriate were compared between intervention and control units within alert categories: (1) recommended medication doses; (2) recommended administration frequencies; (3) recommendations to avoid the drug; (4) warnings of missing information.Results: The rates of alerts were nearly equal in the intervention and control units: 2.5 per 1,000 resident days in the intervention units and 2.4 in the control units. The proportions of dose alerts for which the final drug orders were appropriate were similar between the intervention and control units (relative risk 0.95, 95% confidence interval 0.83, 11) for the remaining alert categories significantly higher proportions of final drug orders were appropriate in the intervention units: relative risk 2.4 for maximum frequency (1.4, 4.4); 2.6 for drugs that should be avoided (1.4, 5.0); and 1.8 for alerts to acquire missing information (1.1, 3.4). Overall, final drug orders were appropriate significantly more often in the intervention units-relative risk 1.2 (1.0, 1.4).Conclusions: Clinical decision support for physicians prescribing medications for long-term care residents with renal insufficiency can improve the quality of prescribing decisions.