一个CKD临床决策支持系统:在初级保健诊所的一个集群随机临床试验
JoAnn Sperl-Hillen1,2, A Lauren Crain1, James B Wetmore3
1HealthPartners Institute, Minneapolis, Minnesota.
Kidney medicine
|March 4, 2024
概括
对慢性病 (CKD) 的临床决策支持系统 (CDS) 并没有显著改善初级保健中的护理质量指标. 随着COVID-19的流行,出现了可能影响研究结果的挑战.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 主要护理医学 医疗保健
- 医疗信息学 医疗信息学
背景情况:
- 在初级保健中,慢性病 (CKD) 管理面临重大挑战.
- 临床决策支持 (CDS) 系统为改善CKD护理质量提供了一个潜在的解决方案.
- 在初级保健中有效实施CDS需要仔细考虑工作流程和患者参与.
研究的目的:
- 开发,实施和评估一个CDS系统,以改善初级保健机构内成年人的CKD护理.
- 评估CKD-CDS干预对CKD管理相关的关键质量指标的影响.
- 确定在初级保健中使用CDS用于CKD的障碍和促进因素.
主要方法:
- 进行了一项集群随机试验,涉及中西部32家初级保健诊所.
- 6,420名成年患者 (18至75岁) 患有CKD G3/G4阶段和至少一个护理差距.
- 干预组接受了CKD-CDS与个性化的建议,而对照组接受了通常的护理.
主要成果:
- 经过18个月的时间,CKD-CDS干预并没有导致大多数评估的CKD质量指标在统计学上显著改善.
- 评估的具体指标包括CKD诊断文档,指示药物的处方,血压和糖化血红蛋白控制,避免使用NSAID,以及科转诊.
- 虽然一些指标显示了轻微的数值差异,但没有一个达到统计学意义,风险比率一般接近1.
结论:
- 实施的CKD-CDS系统在这个初级保健环境中没有显示CKD质量指标的显著改善.
- 冠状病毒疾病2019 (COVID-19) 疫情可能引入了混因素,减少了初级保健接触,并阻碍了CDS的利用.
- 需要进一步的研究来优化CDS设计和实施战略,以在初级保健中管理慢性疾病,特别是在外部干扰的背景下.
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