Stevenson Kurt B, Barbera James, Moore James W, Samore Matthew H, Houck Peter
Qualis Health, Boise, Idaho, USA.
Am J Med Qual. 2005 Nov-Dec;20(6):313-8. doi: 10.1177/1062860605281175.
Electronic clinical decision support systems (CDSS) have been hailed for their potential to improve clinical outcomes. Using a pretest/posttest design, an Internet-based CDSS designed to optimize antimicrobial prescribing was pilot tested for community-acquired pneumonia in 5 rural hospitals in southwestern Idaho. An antimicrobial management team was created in each hospital to address clinicians' perception of excessive time required for direct use of the CDSS. In pooled hospital data, agreement with CDSS recommendations improved to a statistically significant level. However, inspection of data at the individual hospital level demonstrated that almost all improvement occurred in a single hospital. Failure in the other hospitals appeared to be primarily a consequence of organizational and cultural barriers. These barriers are discussed to understand keys for successful future implementation of CDSS in rural hospitals, drawing on experience with cultural barriers from other industries, specifically aviation.
电子临床决策支持系统（CDSS）因其改善临床结果的潜力而备受赞誉。采用前测/后测设计，对一个旨在优化抗菌药物处方的基于互联网的CDSS在爱达荷州西南部的5家乡村医院进行了社区获得性肺炎的试点测试。每家医院都成立了一个抗菌药物管理团队，以解决临床医生对直接使用CDSS所需时间过长的看法。在汇总的医院数据中，与CDSS建议的一致性提高到了具有统计学意义的水平。然而，对各医院层面数据的检查表明，几乎所有的改善都发生在一家医院。其他医院的失败似乎主要是组织和文化障碍造成的。借鉴其他行业（特别是航空业）文化障碍的经验，讨论了这些障碍，以了解未来在乡村医院成功实施CDSS的关键。
