从错误中学习:评估在初级保健中慢性疼痛管理的临床决策支持
Olena Mazurenko1,2, Nate C Apathy2,3, Lindsey M Sanner1
1Department of Health Policy & Management, Richard M. Fairbanks School of Public Health-Indiana University, Indianapolis, Indiana, United States.
Applied clinical informatics
|November 14, 2025
概括
一个用于初级保健中的慢性疼痛管理的临床决策支持工具对指南推的做法产生了最小的影响. 基于电子健康记录的系统,尽管以用户为中心的设计,但并没有导致临床上显著的改善.
科学领域:
- 医疗信息学 医疗信息学
- 初级医疗保健医学 一级医疗保健医学
- 疼痛管理 疼痛管理
背景情况:
- 基于电子健康记录 (EHR) 的临床决策支持 (CDS) 工具旨在改善指南推的护理.
- 在初级保健中,慢性疼痛管理对遵守最佳实践提出了挑战.
研究的目的:
- 评估基于EHR的CDS工具慢性疼痛OneSheet对指南推的初级保健中的慢性疼痛管理的影响.
- 评估被动,选择性CDS干预对临床医生的实践的影响.
主要方法:
- 一项实用随机对照试验与25家诊所的137名初级保健医生 (PCC) 进行.
- 临床医生被随机分配到获得慢性疼痛OneSheet或EHR中的通常护理.
- 结果包括疼痛目标,疼痛和功能 (PEG尺度),处方药监测计划 (PDMP) 审查,尿液药物查 (UDS) 订单和纳洛订单的记录.
主要成果:
- 访问OneSheet显示,与疼痛相关的目标文档 (0.2%),PEG尺度文档 (0.7%) 和UDS订单 (2.2%) 的增长很小.
- 纳洛订单略有下降 (0.5%),PDMP审查率没有显著变化.
- 该干预措施并没有导致临床上显著的改善,指导方针建议的慢性疼痛管理.
结论:
- 基于EHR的慢性疼痛OneSheet没有显著改善指南推的初级保健中的慢性疼痛管理.
- 限制包括目标问题,工作流的限制和外部政策的影响.
- 在复杂的初级保健环境中实施有效的基于EHR的CDS面临重大挑战.
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