Dexter P R, Perkins S, Overhage J M, Maharry K, Kohler R B, McDonald C J
Department of Medicine, Indiana University School of Medicine, Regenstrief Institute for Health Care, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis 46202, USA.
N Engl J Med. 2001 Sep 27;345(13):965-70. doi: 10.1056/NEJMsa010181.
Although they are effective in outpatient settings, computerized reminders have not been proved to increase preventive care in inpatient settings.
We conducted a randomized, controlled trial to determine the effects of computerized reminders on the rates at which four preventive therapies were ordered for inpatients. During an 18-month study period, a computerized system processed on-line information for all 6371 patients admitted to a general-medicine service (for a total of 10,065 hospitalizations), generating preventive care reminders as appropriate. Physicians who were in the intervention group viewed these reminders when they were using a computerized order-entry system for inpatients.
The reminder system identified 3416 patients (53.6 percent) as eligible for preventive measures that had not been ordered by the admitting physician. For patients with at least one indication, computerized reminders resulted in higher adjusted ordering rates for pneumococcal vaccination (35.8 percent of the patients in the intervention group vs. 0.8 percent of those in the control group, P<0.001), influenza vaccination (51.4 percent vs. 1.0 percent, P< 0.001), prophylactic heparin (32.2 percent vs. 18.9 percent, P<0.001), and prophylactic aspirin at discharge (36.4 percent vs. 27.6 percent, P<0.001).
A majority of hospitalized patients in this study were eligible for preventive measures, and computerized reminders significantly increased the rate of delivery of such therapies.
尽管计算机化提醒在门诊环境中有效，但尚未证明其能增加住院患者的预防性护理。
我们进行了一项随机对照试验，以确定计算机化提醒对住院患者四种预防性治疗的医嘱开具率的影响。在为期18个月的研究期间，一个计算机系统处理了普通内科服务收治的所有6371例患者的在线信息（总共10065次住院），并在适当的时候生成预防性护理提醒。干预组的医生在使用住院患者计算机化医嘱录入系统时会查看这些提醒。
提醒系统识别出3416例患者（53.6%）符合接受入院医生未开具的预防性措施的条件。对于至少有一项适应症的患者，计算机化提醒使肺炎球菌疫苗接种的调整后医嘱开具率更高（干预组为35.8%，对照组为0.8%，P<0.001），流感疫苗接种（51.4%对1.0%，P<0.001），预防性肝素（32.2%对18.9%，P<0.001），以及出院时预防性阿司匹林的医嘱开具率（36.4%对27.6%，P<0.001）。
本研究中的大多数住院患者符合接受预防性措施的条件，计算机化提醒显著提高了此类治疗的实施率。
