在结肠直肠癌中脱落实施策略:以服务为导向的CDSSSS的开发,实施和结果
Luciana Rubin1, Marcela Abello1, Alejandro Cruz1
1Hospital Italiano de Buenos Aires, Argentina.
Studies in health technology and informatics
|August 8, 2025
概括
实施了电子健康记录警报,旨在减少老年人不必要的结肠镜检查. 大多数警报都被取消了,这表明需要对基于证据的护理的决策支持进行完善.
科学领域:
- 临床信息学 临床信息学
- 老年医学 老年医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在老年人中,不必要的结肠镜检查意味着大量的医疗费用和潜在的患者伤害.
- 基于证据的指导方针建议,对于75岁及以上的没有特定症状的患者,不建议进行例行结肠镜检查.
- 临床决策支持系统 (CDSS) 提供了一个潜在的途径,使实践与证据保持一致.
研究的目的:
- 开发和实施一个电子健康记录 (EHR) 集成的警报系统.
- 停止对75岁及以上的患者进行可能不必要的结肠镜检查.
- 评估CDSS预警系统的初步结果.
主要方法:
- 一个警报被集成到EHR系统中.
- CDSS为考虑对75岁以上患者进行结肠镜检查的医生发出了警报.
- 收集了关于警报生成,医生覆盖和接受率的数据.
主要成果:
- 从20年8月20日到2024年11月29日,产生了567个警报.
- 对499名患者的244名医生发出了警报.
- 医生无视91.8%的警报,并接受7%.
结论:
- 首次实施CDSS警报时,其接受率很低.
- 需要进一步细化警报的特异性,以提高遵守性.
- 使用CDSS的退出实施策略有望促进老年人以证据为基础的护理.
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