Rocha B H, Christenson J C, Evans R S, Gardner R M
University of Utah, Salt Lake City, Utah.
J Am Med Inform Assoc. 2001 Mar-Apr;8(2):117-25. doi: 10.1136/jamia.2001.0080117.
To analyze whether computer-generated reminders about infections could influence clinicians' practice patterns and consequently improve the detection and management of nosocomial infections.
The conclusions produced by an expert system developed to detect and manage infections were presented to the attending clinicians in a pediatric hospital to determine whether this information could improve detection and management. Clinician interventions were compared before and after the implementation of the system.
The responses of the clinicians (staff physicians, physician assistants, and nurse practitioners) to the reminders were determined by review of paper medical charts. Main outcome measures were the number of suggestions to treat and manage infections that were followed before and after the implementation of COMPISS (Computerized Pediatric Infection Surveillance System). The clinicians' opinions about the system were assessed by means of a paper questionnaire distributed following the experiment.
The results failed to show a statistical difference between the clinicians' treatment strategies before and after implementation of the system (P: > 0.33 for clinicians working in the emergency room and P: > 0.45 for clinicians working in the pediatric intensive care unit). The questionnaire results showed that the respondents appreciated the information presented by the system.
The computer-generated reminders about infections were unable to influence the practice patterns of clinicians. The methodologic problems that may have contributed to this negative result are discussed.
分析计算机生成的感染提醒是否会影响临床医生的执业模式，进而改善医院感染的检测与管理。
将一个用于检测和管理感染的专家系统得出的结论呈现给一家儿科医院的主治医生，以确定该信息是否能改善检测与管理。对系统实施前后的临床医生干预措施进行比较。
通过查阅纸质病历确定临床医生（主治医师、医师助理和执业护士）对提醒的反应。主要结局指标是在实施COMPISS（计算机化儿科感染监测系统）前后遵循的治疗和管理感染建议的数量。通过实验后分发的纸质问卷评估临床医生对该系统的意见。
结果未显示系统实施前后临床医生的治疗策略存在统计学差异（急诊室工作的临床医生P值>0.33，儿科重症监护病房工作的临床医生P值>0.45）。问卷调查结果显示，受访者对系统提供的信息表示赞赏。
计算机生成的感染提醒无法影响临床医生的执业模式。讨论了可能导致这一负面结果的方法学问题。
