临床决策支持对心力衰竭的持续影响:使用实施科学进行的自然实验
Katy E Trinkley1,2,3, Garth Wright3, Larry A Allen4,5
1Department of Family Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States.
Applied clinical informatics
|October 18, 2023
概括
增强的临床决策支持 (CDS) 改善了基于证据的贝塔抑制剂 (BB) 对心力衰竭的处方. 与商业工具相比,这种定制的CDS显示了持续的现实世界的有效性和临床医生的采用.
科学领域:
- 医疗信息学 医疗信息学
- 实施科学 实施科学
- 心脏病学 心脏病学
背景情况:
- 临床决策支持 (CDS) 工具可以改善基于证据的处方.
- 商用CDS工具可能缺乏定制以实现最佳有效性.
- 实施科学 (IS) 提供了增强CDS设计和采用的方法.
研究的目的:
- 评估与商业CDS相比,增强型CDS在现实世界中的持续效果.
- 评估临床医生采用和提高CDS在初级保健中的有效性.
- 确定IS方法是否能改善心力衰竭管理中的CDS结果.
主要方法:
- 一个自然实验比较了28个使用商业CDS (预期) 和增强CDS (两期) 的初级保健诊所.
- 主要结果:导致心力衰竭的β阻断剂 (BB) 处方的警报比例.
- 二次结果:患者覆盖范围和临床医生采用 (提醒解雇).
主要成果:
- 与商业CDS (95%CI:17.0-35.1%) 相比,增强的CDS增加了26.1%的BB处方.
- 临床采用率明显高于增强的CDS (OR: 4.17) 与商业CDS (81%对29%).
- 从预期到后期,增强型CDS的采用率从62%增加到92%,有效率从14%增加到10%.
结论:
- 应用IS方法和CDS最佳实践导致了改善和持续的临床医生采用和有效性.
- 与标准的商业CDS工具相比,增强的CDS在现实世界中表现出更高的性能.
- 定制的CDS干预措施对于优化初级保健机构的基于证据的处方至关重要.
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