将临床决策支持系统进行比较,以改善对异常宫癌查测试结果的随访
Steven J Atlas1, Timothy E Burdick2, Adam Wright3
1Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
临床决策支持系统 (CDSS) 与患者外展相结合,显著改善了宫癌查结果异常的随访护理. 单独的CDSS并没有改善结果,这凸显了综合患者支持策略对及时癌症查跟踪的重要性.
科学领域:
- 公共卫生 公共卫生
- 医疗信息学 医疗信息学
- 在瘤学瘤学.
背景情况:
- 及时对异常的宫癌查进行后续检查至关重要,但往往会延迟.
- 临床决策支持系统 (CDSS) 在整合复杂的指导方针和临床数据方面面临挑战.
- 两种CDSS模型,一种使用自然语言处理 (A系统),另一种使用EHR数据 (B系统),在一个多站点试验中进行了比较.
研究的目的:
- 为了比较两个不同的CDSS模型在改善异常宫癌查结果后续护理方面的准确性和有效性.
- 评估CDSS的影响,有或没有患者外展/导航,对随访完成率的影响.
主要方法:
- 一项涉及44家初级保健诊所的随机试验,将通常护理与CDSS单独或CDSS加患者外展/导航进行比较.
- CDSS确定了逾期异常查结果的患者,并推了后续行动.
- 手动图表审查评估了CDSS的准确性;120天后的患者随访是主要结果.
主要成果:
- CDSS准确度中等,B系统 (70.4%) 的表现优于A系统 (61.3%).
- 单独使用CDSS并没有改善与常规护理相比的随访率.
- 结合患者外展 (带或不带导航) 的CDSS,在A系统和B系统中显著增加了随访率.
结论:
- 两种CDSS模型都在识别需要随访的患者方面表现出适度的准确性.
- 患者外展对于改善随访率至关重要;单独的CDSS是不够的.
- 未来的宫癌查CDSS可以从开源工具和公私合作伙伴关系中获益,以提高有效性.
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