PDF(Pubmed)
Abstract：
UNASSIGNED: Clinical decision support systems (CDSSs) embedded in electronic medical records (EMRs), also called electronic health records, have the potential to improve the adoption of clinical guidelines. The University of Alberta Inflammatory Bowel Disease (IBD) Group developed a CDSS for patients with IBD who might be experiencing disease flare and deployed it within a clinical information system in 2 continuous time periods.
UNASSIGNED: This study aims to evaluate the impact of the IBD CDSS on the adherence of health care providers (ie, physicians and nurses) to institutionally agreed clinical management protocols.
UNASSIGNED: A 2-period interrupted time series (ITS) design, comparing adherence to a clinical flare management protocol during outpatient visits before and after the CDSS implementation, was used. Each interruption was initiated with user training and a memo with instructions for use. A group of 7 physicians, 1 nurse practitioner, and 4 nurses were invited to use the CDSS. In total, 31,726 flare encounters were extracted from the clinical information system database, and 9217 of them were manually screened for inclusion. Each data point in the ITS analysis corresponded to 1 month of individual patient encounters, with a total of 18 months of data (9 before and 9 after interruption) for each period. The study was designed in accordance with the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) guidelines for health informatics evaluations.
UNASSIGNED: Following manual screening, 623 flare encounters were confirmed and designated for ITS analysis. The CDSS was activated in 198 of 623 encounters, most commonly in cases where the primary visit reason was a suspected IBD flare. In Implementation Period 1, before-and-after analysis demonstrates an increase in documentation of clinical scores from 3.5% to 24.1% (P<.001), with a statistically significant level change in ITS analysis (P=.03). In Implementation Period 2, the before-and-after analysis showed further increases in the ordering of acute disease flare lab tests (47.6% to 65.8%; P<.001), including the biomarker fecal calprotectin (27.9% to 37.3%; P=.03) and stool culture testing (54.6% to 66.9%; P=.005); the latter is a test used to distinguish a flare from an infectious disease. There were no significant slope or level changes in ITS analyses in Implementation Period 2. The overall provider adoption rate was moderate at approximately 25%, with greater adoption by nurse providers (used in 30.5% of flare encounters) compared to physicians (used in 6.7% of flare encounters).
UNASSIGNED: This is one of the first studies to investigate the implementation of a CDSS for IBD, designed with a leading EMR software (Epic Systems), providing initial evidence of an improvement over routine care. Several areas for future research were identified, notably the effect of CDSSs on outcomes and how to design a CDSS with greater utility for physicians. CDSSs for IBD should also be evaluated on a larger scale; this can be facilitated by regional and national centralized EMR systems.
UNASSIGNED: This study aims to evaluate the impact of the IBD CDSS on the adherence of health care providers (ie, physicians and nurses) to institutionally agreed clinical management protocols.
UNASSIGNED: A 2-period interrupted time series (ITS) design, comparing adherence to a clinical flare management protocol during outpatient visits before and after the CDSS implementation, was used. Each interruption was initiated with user training and a memo with instructions for use. A group of 7 physicians, 1 nurse practitioner, and 4 nurses were invited to use the CDSS. In total, 31,726 flare encounters were extracted from the clinical information system database, and 9217 of them were manually screened for inclusion. Each data point in the ITS analysis corresponded to 1 month of individual patient encounters, with a total of 18 months of data (9 before and 9 after interruption) for each period. The study was designed in accordance with the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) guidelines for health informatics evaluations.
UNASSIGNED: Following manual screening, 623 flare encounters were confirmed and designated for ITS analysis. The CDSS was activated in 198 of 623 encounters, most commonly in cases where the primary visit reason was a suspected IBD flare. In Implementation Period 1, before-and-after analysis demonstrates an increase in documentation of clinical scores from 3.5% to 24.1% (P<.001), with a statistically significant level change in ITS analysis (P=.03). In Implementation Period 2, the before-and-after analysis showed further increases in the ordering of acute disease flare lab tests (47.6% to 65.8%; P<.001), including the biomarker fecal calprotectin (27.9% to 37.3%; P=.03) and stool culture testing (54.6% to 66.9%; P=.005); the latter is a test used to distinguish a flare from an infectious disease. There were no significant slope or level changes in ITS analyses in Implementation Period 2. The overall provider adoption rate was moderate at approximately 25%, with greater adoption by nurse providers (used in 30.5% of flare encounters) compared to physicians (used in 6.7% of flare encounters).
UNASSIGNED: This is one of the first studies to investigate the implementation of a CDSS for IBD, designed with a leading EMR software (Epic Systems), providing initial evidence of an improvement over routine care. Several areas for future research were identified, notably the effect of CDSSs on outcomes and how to design a CDSS with greater utility for physicians. CDSSs for IBD should also be evaluated on a larger scale; this can be facilitated by regional and national centralized EMR systems.
摘要：
■嵌入在电子病历（EMR）中的临床决策支持系统（CDS），也被称为电子健康记录，有可能改善临床指南的采用。阿尔伯塔大学炎症性肠病（IBD）小组为可能正在经历疾病发作的IBD患者开发了CDSS，并在2个连续时间段内将其部署在临床信息系统中。
■本研究旨在评估IBDCDSS对医疗保健提供者依从性的影响（即，医师和护士)到机构商定的临床管理方案。
■2周期中断时间序列（ITS）设计，比较CDSS实施前后门诊就诊期间对临床耀斑管理方案的依从性，被使用。每次中断都是通过用户培训和使用说明的备忘录启动的。一组7名医生，1名执业护士，邀请4名护士使用CDSS。总的来说,从临床信息系统数据库中提取了31,726次耀斑遭遇，其中9217人被手动筛选纳入。ITS分析中的每个数据点对应于1个月的个体患者遭遇，每个周期总共18个月的数据（中断前9个，中断后9个）。该研究是根据健康信息学评估报告（STARE-HI）指南设计的。
■手动筛选后，确认了623次耀斑遭遇，并指定用于ITS分析。CDSS在623次遭遇中的198次中被激活，最常见于主要就诊原因是疑似IBD发作的病例。在实施期1中，前后分析表明，临床评分的记录从3.5％增加到24.1％（P<.001），在ITS分析中具有统计学上显著的水平变化(P=0.03)。在实施期2中，前后分析显示急性疾病耀斑实验室测试的顺序进一步增加（47.6％至65.8％；P<.001），包括生物标志物粪便钙卫蛋白（27.9％至37.3％;P=0.03）和粪便培养测试（54.6％至66.9％;P=.005）;后者是用于区分耀斑与传染病的测试。在实施期2中，ITS分析没有显著的斜率或水平变化。总体提供商采用率中等，约为25%，与医生（在6.7％的耀斑中使用）相比，护士提供者的采用率更高（在30.5％的耀斑中使用）。
■这是第一批调查IBDCDSS实施情况的研究之一，采用领先的EMR软件（EpicSystems）设计，提供改善常规护理的初步证据。确定了未来研究的几个领域，特别是CDS对结果的影响，以及如何设计对医生更实用的CDSS。IBD的CDSS也应进行更大规模的评估；区域和国家集中式EMR系统可以促进这一点。
■本研究旨在评估IBDCDSS对医疗保健提供者依从性的影响（即，医师和护士)到机构商定的临床管理方案。
■2周期中断时间序列（ITS）设计，比较CDSS实施前后门诊就诊期间对临床耀斑管理方案的依从性，被使用。每次中断都是通过用户培训和使用说明的备忘录启动的。一组7名医生，1名执业护士，邀请4名护士使用CDSS。总的来说,从临床信息系统数据库中提取了31,726次耀斑遭遇，其中9217人被手动筛选纳入。ITS分析中的每个数据点对应于1个月的个体患者遭遇，每个周期总共18个月的数据（中断前9个，中断后9个）。该研究是根据健康信息学评估报告（STARE-HI）指南设计的。
■手动筛选后，确认了623次耀斑遭遇，并指定用于ITS分析。CDSS在623次遭遇中的198次中被激活，最常见于主要就诊原因是疑似IBD发作的病例。在实施期1中，前后分析表明，临床评分的记录从3.5％增加到24.1％（P<.001），在ITS分析中具有统计学上显著的水平变化(P=0.03)。在实施期2中，前后分析显示急性疾病耀斑实验室测试的顺序进一步增加（47.6％至65.8％；P<.001），包括生物标志物粪便钙卫蛋白（27.9％至37.3％;P=0.03）和粪便培养测试（54.6％至66.9％;P=.005）;后者是用于区分耀斑与传染病的测试。在实施期2中，ITS分析没有显著的斜率或水平变化。总体提供商采用率中等，约为25%，与医生（在6.7％的耀斑中使用）相比，护士提供者的采用率更高（在30.5％的耀斑中使用）。
■这是第一批调查IBDCDSS实施情况的研究之一，采用领先的EMR软件（EpicSystems）设计，提供改善常规护理的初步证据。确定了未来研究的几个领域，特别是CDS对结果的影响，以及如何设计对医生更实用的CDSS。IBD的CDSS也应进行更大规模的评估；区域和国家集中式EMR系统可以促进这一点。
