基于电子医疗记录的临床决策支持系统对在炎症性肠病护理中遵守临床协议的影响:中断时间序列研究
Reed Taylor Sutton1, Kaitlyn Delaney Chappell1, David Pincock2
1Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
临床决策支持系统 (CDSS) 改善了对炎症性肠病 (IBD) 准则的遵守. 虽然采用程度适度,但CDSS在改善IBD爆发的护理方案方面取得了初步成功.
科学领域:
- 医疗信息学 医疗信息学
- 改善临床实践的改善
- 炎症性肠道疾病管理管理
背景情况:
- 集成到电子医疗记录 (EMR) 中的临床决策支持系统 (CDSS) 可以提高对临床指南的遵守.
- 针对炎症性肠病 (IBD) 爆发的特定CDSS已在临床信息系统中开发和实施.
研究的目的:
- 评估IBD CDSS对医疗保健提供者遵守疾病爆发的临床管理协议的影响.
- 评估CDSS在改善对IBD患者采用基于证据的护理方面的有效性.
主要方法:
- 使用2期中断时间序列 (ITS) 设计来比较CDSS实施前后的坚持.
- 分析了来自临床信息系统数据库的623个已确认的爆发事件,持续了18个月 (实施前9个月和实施后9个月).
- 采用人工查和统计分析,遵守STARE-HI健康信息学评估指南.
主要成果:
- 实施期1显示,临床评分文档显著增加 (3.5%至24.1%,P<.001).
- 实施期2显示急性发作实验室测试的排序增加,包括便calprotectin (47.6%至65.8%,P<.001).
- 整体提供者采用率中等 (~25%),护士 (30.5%) 的使用率高于医生 (6.7%).
结论:
- 与Epic EMR集成的IBD CDSS提供了与常规护理相比,更好地遵守临床方案的初步证据.
- 需要进一步的研究来评估CDSS对患者结果的影响,并优化医生可用性.
- 建议对IBDCDSS进行大规模评估,利用集中式EMR系统.
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