FAMILY LINKAGES SUPPORTING HYPERBILIRUBIN GUIDELINES

减黄时代新生儿黄疸的最佳治疗 产后住院时间要求提供临床服务 护理地点的信息以及遵守以下准则的情况 诊断和管理。该项目将建立一个基于计算机的 将跨机构的关键临床数据联系起来的信息系统 并提供基于计算机的决策支持(CDSS)以增强遵从性 高胆红素血症的治疗指南。具体的 该项目的目的是证明将 使用允许共享临床信息的体系结构 来自不同电子病历系统的患者数据 维持高度的安全；并向临床医生提供CDSS 看到患有黄疸的婴儿。该项目将决定是否使用 这一计划的结果是加强了对指导方针的遵守，改变 在资源使用方面，并加强了有关管理的知识。 我们将在#年在两家主要产科医院实施这一计划。 波士顿布里格姆妇女医院和贝丝以色列医院， 波士顿所有新生儿分娩的60%加在一起；出生数据 将链接到初级保健和急诊科站点，地址为 波士顿儿童医院，以及一个私人社区 练习一下。这项计划的影响将通过准- 实验设计，使用前后测量，在 干预和匹配的非干预地点。数据将被派生 来自基于医疗审查标准的图表审查，以及对 研究现场的临床医生。使用的指导方针将是美国人 儿科学会高胆红素血症治疗指南， 在儿童医院通过正式的指导程序进行局部适应 波士顿医院。 该项目针对的是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来将数据链接到 护理地点，以加强沟通，减少重复； 并将深入了解基于计算机的决策的有效性 作为加强实践执行的机制的支助 指导方针，以减少护理的变异性，提高质量，并 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.