在医疗住院患者中进行血栓预防的临床决策支持:一个集群随机试验
Alex C Spyropoulos1,2, Mark Goldin1,2, Ioannis Koulas1
1Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.
JACC. Advances
|June 28, 2024
概括
实施电子健康记录集成的临床决策支持 (CDS) 改善了住院患者的血栓预防率. 这种干预减少了静脉和动脉血栓塞栓事件,但与死亡率增加有关.
科学领域:
- 医疗信息学 医疗信息学
- 临床医学 临床医学
- 公共卫生 公共卫生
背景情况:
- 血栓预防在住院和出院后的医疗病患者中未得到充分利用.
- 集成到电子健康记录 (EHR) 中的临床决策支持 (CDS) 可以提高预防率.
- 经过验证的模型对于有效的CDS实施至关重要.
研究的目的:
- 评估一个通用EHR集成的CDS工具的临床影响.
- 该工具基于国际医学预防注册表的静脉血栓栓塞瘤加D-Dimer模型.
- 评估CDS在改善血栓预防中的有效性.
主要方法:
- 一个集群随机试验,涉及4所高等学术医院.
- 纳入标准:60岁以上有关键医学疾病的住院患者.
- 干预组在入院和出院时接受了CDS;对照组接受了通常的护理.
主要成果:
- 在干预组中,适当的血栓预防显著增加 (住院患者:80.1%vs72.5%;出院:13.6%vs7.5%).
- 在干预组中观察到静脉,动脉和全血栓栓塞的发病率降低.
- 大型出血没有显著差异;然而,干预组的死亡率更高 (9.1%vs7.0%).
结论:
- 嵌入EHR的CDS有效地增加了医疗病患者的适当血栓预防.
- 该CDS工具减少了血栓栓塞发生的事件,而没有增加大出血.
- 干预组中较高的死亡率需要进一步调查.
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