Shiffman R N, Liaw Y, Brandt C A, Corb G J
Center for Medical Informatics, Yale School of Medicine, New Haven, CT 06520-8009, USA.
J Am Med Inform Assoc. 1999 Mar-Apr;6(2):104-14. doi: 10.1136/jamia.1999.0060104.
In this systematic review, the authors analyze the functionality provided by recent computer-based guideline implementation systems and characterize the effectiveness of the systems. Twenty-five studies published between 1992 and January 1998 were identified. Articles were included if the authors indicated an intent to implement guideline recommendations for clinicians and if the effectiveness of the system was evaluated. Provision of eight information management services and effects on guideline adherence, documentation, user satisfaction, and patient outcome were noted. All systems provided patient-specific recommendations. In 19, recommendations were available concurrently with care. Explanation services were described for nine systems. Nine systems allowed interactive documentation, and 17 produced paper-based output. Communication services were present most often in systems integrated with electronic medical records. Registration, calculation, and aggregation services were infrequently reported. There were 10 controlled trials (9 randomized) and 10 time-series correlational studies. Guideline adherence improved in 14 of 18 systems in which it was measured. Documentation improved in 4 of 4 studies.
在本系统评价中，作者分析了近期基于计算机的指南实施系统所提供的功能，并描述了这些系统的有效性。确定了1992年至1998年1月期间发表的25项研究。如果作者表明有意为临床医生实施指南建议且评估了系统的有效性，则纳入相关文章。记录了八项信息管理服务的提供情况以及对指南依从性、文档记录、用户满意度和患者结局的影响。所有系统均提供针对患者的建议。其中19个系统的建议可与护理同时提供。九个系统描述了解释服务。九个系统允许交互式文档记录，17个系统生成纸质输出。通信服务在与电子病历集成的系统中最为常见。注册、计算和汇总服务的报告较少。有10项对照试验（9项随机试验）和10项时间序列相关性研究。在18个被测量的系统中，有14个系统的指南依从性得到改善。在4项研究中有4项的文档记录得到改善。
