预防静脉血栓栓塞的临床决策支持系统:对医生行为的影响
P Durieux1, R Nizard, P Ravaud
1Santé Publique, Faculté de Médecine Broussais Hôtel Dieu, 15 rue de l'Ecole de Médecine, 75006 Paris, France. pierre.durieux@egp.ap-hop-paris.fr
JAMA
|June 6, 2000
概括
实施临床决策支持系统 (CDSS) 显著改善了医生在骨科手术中遵守静脉血栓塞栓症预防指南. 该CDSS显然对适当的临床实践决策产生了明显的影响.
科学领域:
- 医疗信息学 医疗信息学
- 改善临床实践的改善
- 医疗保健服务研究 医疗服务研究
背景情况:
- 基于计算机的临床决策支持系统 (CDSS) 显示出提高医疗保健质量的潜力.
- 在CDSS在临床环境中被广泛采用之前,严格的评估至关重要.
研究的目的:
- 评估通过CDSS提出静脉血栓塞栓症 (VTE) 预防指南是否能改善适当的临床实践决策.
- 评估CDSS对VTE预防指南在骨科手术中的遵守的影响.
主要方法:
- 一项时间序列研究,涉及1971年巴黎一家教学医院的骨科手术患者 (1997年12月至1999年7月).
- 在10周的交替干预和控制期间,将用于预防VTE的CDSS整合到日常实践中.
- 根据指南,在干预期和控制期之间比较了适当的抗凝剂处方率.
主要成果:
- 医生遵守VTE预防指南的比例从控制期的82.8%增加到干预期的94.9%.
- 在CDSS干预期间,处方的适当性显著改善 (P<.001).
- 与干预期间相比,在控制期间,不适当的做法决定的可能性是干预期间的3.8倍.
结论:
- 在骨科手术中进行静脉瘤预防的CDSS的常规实施有效地改变了医生的行为.
- 综合的CDSS显著改善了对VTE预防的既定临床指南的遵守.
- 当CDSS被移除时,医生实践恢复到基线,突出显示了其持续的影响.
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