临床决策支持系统的混合方法评估,以减少医疗保健的变化
Anton Pak1, Samantha T Robertson2, Bao Hoang Nguyen3
1Centre for the Business and Economics of Health, The University of Queensland, Brisbane, QLD, Australia. a.pak@uq.edu.au.
临床决策支持系统 (CDSS) 在改善复杂紧急情况的患者结果方面表现有前途. 增加CDSS的使用与住院时间缩短和死亡率降低相关,尽管意识和培训是关键障碍.
科学领域:
- 医疗信息学 医疗信息学
- 医疗保健服务研究 医疗服务研究
- 临床实践指南 临床实践指南
背景情况:
- 临床决策支持系统 (CDSS) 在减少护理变异和改善急性高风险疾病的结果方面有效性的证据有限.
- 在管理复杂的代谢紧急情况时,偏离临床指导方针可能会带来重大成本.
研究的目的:
- 评估CDSS嵌入式护理计划对复杂代谢紧急情况的管理的利用和影响.
- 评估CDSS利用与患者结果之间的关联,包括住院时间和住院死亡率.
主要方法:
- 在电子病历中对345个涉及CDSS嵌入式护理计划的护理事件进行了回顾性评估.
- 对使用率,住院时间和住院死亡率的定量分析.
- 对14次临床医生采访进行了定性分析,以确定CDSS使用的障碍和促进因素.
主要成果:
- 在345个评估的事件中,CDSS被用于超过一半.
- CDSS利用率增加1%与住院时间减少1.3%有关.
- 任何使用CDSS的情况都与3.3%的住院死亡率降低有关.
结论:
- 精心设计的CDSS护理计划显示出在复杂的代谢紧急情况中减少临床变异和改善患者结果的潜力.
- 临床医生的意识,教育和工作流集成是最大限度地提高CDSS价值和有意义的使用的关键因素.
- 需要进一步的研究和实施策略来克服障碍并提高CDSS的有效性.
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