Hoch Isaac, Heymann Anthony D, Kurman Irena, Valinsky Liora J, Chodick Gabi, Shalev Varda
Department of Community Health, Maccabi Healthcare Services, Tel Aviv, Israel.
J Am Med Inform Assoc. 2003 Nov-Dec;10(6):541-6. doi: 10.1197/jamia.M1353. Epub 2003 Aug 4.
More than 20% of approximately 35,000 patients filling a diuretic prescription had no potassium blood test recorded within the previous year. A laboratory reporting system used throughout Israel by Maccabi Healthcare Services physicians was modified to provide physician alerts regarding potassium testing. The physicians were experienced users of a computerized medical record (CMR) that provided online laboratory test results. A nightly batch file checked pharmacy diuretic purchases against the patient's potassium blood test status. On-screen computer-generated reminders were sent to physicians of patients lacking a recent potassium test. Reminders to clinicians increased potassium testing by 9.8% (p < 0.001). Physician age and gender played a small part in predicting compliance to the alert, but specialty and practice size did not. The time delay between the date a reminder was sent and the potassium test date decreased steadily during the intervention. The success of this reminder system encourages expansion to include more drug-laboratory interactions. Furthermore, direct alerts to patients at multiple organization/patient contact points are planned.
在约35000名开具利尿剂处方的患者中，超过20%的患者在前一年没有血钾检测记录。以色列各地的马卡比医疗服务公司的医生所使用的实验室报告系统进行了修改，以向医生发出有关血钾检测的警报。这些医生是使用提供在线实验室检测结果的计算机化病历（CMR）的经验丰富的用户。一个夜间批处理文件会对照患者的血钾检测状态检查药房的利尿剂采购情况。针对近期未进行血钾检测的患者，会向医生发送计算机生成的屏幕提醒。向临床医生发出提醒后，血钾检测增加了9.8%（p<0.001）。医生的年龄和性别在预测对警报的依从性方面作用较小，但专业和诊所规模则不然。在干预期间，从发出提醒之日到血钾检测日期之间的时间间隔稳步缩短。这个提醒系统的成功鼓励将其扩展到包括更多药物-实验室相互作用的情况。此外，还计划在多个组织/患者接触点直接向患者发出警报。
