Digitalizing Clinical Guidelines: Experiences in the Development of Clinical Decision Support Algorithms for Management of Childhood Illness in Resource-Constrained Settings.

数字化临床指南 ： 在资源受限的环境中开发用于儿童疾病管理的临床决策支持算法的经验。

• 影响指数: 3.409
• 发表时间: 2023 08 28
• 来源期刊: Glob Health Sci Pract
• DOI: 10.9745/GHSP-D-22-00439
• PMID: 37640492
• 文章类型: Journal Article
• 作者列表: Beynon F,Guérin F,Lampariello R,Schmitz T,Tan R,Ratanaprayul N,Tamrat T,Pellé KG,Catho G,Keitel K,Masanja I,Rambaud-Althaus C

Mesh: Child; Humans; Decision Support Systems, Clinical; Algorithms; Ichthyosiform Erythroderma, Congenital; Lipid Metabolism, Inborn Errors

Abstract

Clinical decision support systems (CDSSs) can strengthen the quality of integrated management of childhood illness (IMCI) in resource-constrained settings. Several IMCI-related CDSSs have been developed and implemented in recent years. Yet, despite having a shared starting point, the IMCI-related CDSSs are markedly varied due to the need for interpretation when translating narrative guidelines into decision logic combined with considerations of context and design choices. Between October 2019 and April 2021, we conducted a comparative analysis of 4 IMCI-related CDSSs. The extent of adaptations to IMCI varied, but common themes emerged. Scope was extended to cover a broader range of conditions. Content was added or modified to enhance precision, align with new evidence, and support rational resource use. Structure was modified to increase efficiency, improve usability, and prioritize care for severely ill children. The multistakeholder development processes involved syntheses of recommendations from existing guidelines and literature; creation and validation of clinical algorithms; and iterative development, implementation, and evaluation. The common themes surrounding adaptations of IMCI guidance highlight the complexities of digitalizing evidence-based recommendations and reinforce the rationale for leveraging standards for CDSS development, such as the World Health Organization\'s SMART Guidelines. Implementation through multistakeholder dialogue is critical to ensure CDSSs can effectively and equitably improve quality of care for children in resource-constrained settings.

摘要

临床决策支持系统（CDS）可以在资源有限的环境中提高儿童疾病综合管理（IMCI）的质量。近年来，已经开发并实施了几种与IMCI相关的CDS。然而，尽管有一个共同的起点，与IMCI相关的CDS在将叙述性指南转换为决策逻辑时需要进行解释,同时考虑上下文和设计选择,因此差异显著.在2019年10月至2021年4月之间，我们对4个IMCI相关的CDS进行了比较分析。对IMCI的适应程度各不相同，但是共同的主题出现了。范围扩大到涵盖更广泛的条件。添加或修改内容以提高精度，与新证据保持一致，支持合理利用资源。结构被修改以提高效率，提高可用性，并优先照顾重病儿童。多利益相关方开发过程涉及现有指南和文献中的建议的综合；临床算法的创建和验证；迭代开发，实施，和评价。围绕IMCI指南调整的共同主题突出了基于证据的建议数字化的复杂性，并加强了利用CDSS开发标准的理由。例如世界卫生组织的SMART指南。通过多方利益攸关方对话的实施对于确保社区发展中心能够有效和公平地提高资源有限环境中儿童的护理质量至关重要。