FAMILY LINKAGES SUPPORTING HYPERBILIRUBIN GUIDELINES

新生儿黄疸在减胎时代的优化管理 产后住院时间要求提供临床 护理中心的信息以及遵守 诊断和管理。 该项目将建立一个基于计算机的 信息系统将链接各机构的关键临床数据 并提供基于计算机的决策支持（CDSS），以提高依从性 高胆红素血症管理指南。 具体 该项目的目的是证明连接的可行性， 使用允许共享的架构的临床信息 来自异构电子医疗记录系统的患者数据， 维持高水平的安全性;以及向临床医生提供CDSS 看黄疸的婴儿 该项目将确定是否使用 这一计划的结果是加强遵守准则，改变 在资源利用方面，并加强了有关管理的知识。 我们将在两个主要的产科医院实施这一计划， 波士顿布里格姆妇女医院和贝斯以色列医院， 一起提供了波士顿所有新生儿分娩的60%;出生数据 将链接到初级保健和急诊科网站， 波士顿儿童医院，以及一个私人社区 实践 该计划的影响将通过准- 实验设计，使用前后测量， 干预和匹配的非干预网站。 数据将被导出 从基于病历审查的医疗审查标准，以及 研究中心的临床医生。 使用的指南将是美国 儿科学会高胆红素血症管理指南， 通过在儿童基金会的正式指导过程， 波士顿，医院。 该项目针对一个重要的临床实体-新生儿黄疸; 它将展示一种广泛适用的机制， 护理场所，以加强沟通和减少重复; 并将深入了解计算机决策的有效性 支持作为一种机制，以加强实践的执行 指导方针，以减少护理的变异性，提高质量， 降低成本。

The optimal management of neonates with jaundice in an era of reduced post partum length of stay requires the availability of clinical information across sites of care as well as adherence to guidelines for diagnosis and management. This project will establish a computer based information system that will link key clinical data across institutions and provide computer based decision support (CDSS) to enhance adherence to guidelines for the management of hyperbilirubinemia. The specific aims of the project are to demonstrate the feasibility of linking clinical information using an architecture that permits the sharing of patient data from heterogeneous electronic medical record systems while maintaining a high level of security; and of providing CDSS to clinicians seeing infants with jaundice. The project will determine whether the use of this program results in enhanced adherence to the guideline, changes in resource use, and enhanced knowledge concerning management. We will implement this program at two major obstetric hospitals in Boston, Brigham and Women's Hospital and Beth Israel Hospital, which together provide 60% of all newborn deliveries in Boston; The birth data will be linked to primary care and emergency department sites at Children's Hospital, Boston, as well as to a private community based practice. The impact of this program will be assessed with a quasi- experimental design, using before and after measurements at both intervention and matched non-intervention sites. Data will be derived from medical review criteria based chart review, as well as surveys of clinicians at study sites. The guideline used will be the American Academy of Pediatrics guideline for the management of hyperbilirubinemia, with local adaptation through a formal guideline process at Children's Hospital, Boston. The project addresses an important clinical entity, neonatal jaundice; it will demonstrate a broadly applicable mechanism to link data across sites of care in order to enhance communication and decrease duplication; and will give insight into the effectiveness of computer based decision support as a mechanism to enhance the implementation of practice guidelines in order to reduce variability in care, improve quality, and reduce cost.