McGregor Jessina C, Weekes Elizabeth, Forrest Graeme N, Standiford Harold C, Perencevich Eli N, Furuno Jon P, Harris Anthony D
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, 100 North Greene Street, Lower Level, Baltimore, MD 21201, USA.
J Am Med Inform Assoc. 2006 Jul-Aug;13(4):378-84. doi: 10.1197/jamia.M2049. Epub 2006 Apr 18.
Many hospitals utilize antimicrobial management teams (AMTs) to improve patient care. However, most function with minimal computer support. We evaluated the effectiveness and cost-effectiveness of a computerized clinical decision support system for the management of antimicrobial utilization.
A randomized controlled trial in adult inpatients between May 10 and August 3, 2004. Antimicrobial utilization was managed by an existing AMT using the system in the intervention arm and without the system in the control arm. The system was developed to alert the AMT of potentially inadequate antimicrobial therapy.
Outcomes assessed were hospital antimicrobial expenditures, mortality, length of hospitalization, and time spent managing antimicrobial utilization.
The AMT intervened on 359 (16%) of 2,237 patients in the intervention arm and 180 (8%) of 2,270 in the control arm, while spending approximately one hour less each day on the intervention arm. Hospital antimicrobial expenditures were $285,812 in the intervention arm and $370,006 in the control arm, for a savings of $84,194 (23%), or $37.64 per patient. No significant difference was observed in mortality (3.26% vs. 2.95%, p = 0.55) or length of hospitalization (3.84 vs. 3.99 days, p = 0.38).
Use of the system facilitated the management of antimicrobial utilization by allowing the AMT to intervene on more patients receiving inadequate antimicrobial therapy and to achieve substantial time and cost savings for the hospital. This is the first study that demonstrates in a patient-randomized controlled trial that computerized clinical decision support systems can improve existing antimicrobial management programs.
许多医院利用抗菌药物管理团队（AMT）来改善患者护理。然而，大多数团队在计算机支持极少的情况下开展工作。我们评估了一个用于抗菌药物使用管理的计算机化临床决策支持系统的有效性和成本效益。
2004年5月10日至8月3日对成年住院患者进行的一项随机对照试验。在干预组中，抗菌药物使用由现有的AMT使用该系统进行管理，而在对照组中则不使用该系统。该系统旨在提醒AMT注意潜在的抗菌治疗不足情况。
评估的结果包括医院抗菌药物支出、死亡率、住院时间以及管理抗菌药物使用所花费的时间。
干预组2237名患者中有359名（16%）得到了AMT的干预，对照组2270名患者中有%180名（8%）得到了干预，同时干预组每天花费的时间大约少一小时。干预组的医院抗菌药物支出为285,812美元，对照组为370,006美元，节省了84,194美元（23%），即每位患者节省37.64美元。在死亡率（3.26%对2.95%，p = 0.55）或住院时间（3.84天对3.99天，p = 0.38）方面未观察到显著差异。
该系统的使用有助于抗菌药物使用的管理，使AMT能够对更多接受抗菌治疗不足的患者进行干预，并为医院节省大量时间和成本。这是第一项在患者随机对照试验中证明计算机化临床决策支持系统可以改善现有抗菌药物管理项目的研究。
