Chisolm Deena J, McAlearney Ann Scheck, Veneris Sofia, Fisher David, Holtzlander Melissa, McCoy Karen S
Columbus Children's Research Institute, Columbus, OH 43205, USA.
Pediatr Allergy Immunol. 2006 May;17(3):199-206. doi: 10.1111/j.1399-3038.2005.00362.x.
Condition-specific order sets within computerized physician order entry (CPOE) systems are designed to decrease unnecessary practice variation and to promote evidence-based practice. This study quantitatively assessed the relationship between use of a computerized order set and processes of care in inpatient pediatric asthma treatment, and qualitatively assessed user attitudes toward order set use. The study population included 790 patients with a primary diagnosis of asthma admitted to Columbus Children's Hospital between November 1, 2001 and November 30, 2003. Rates of systemic corticosteroid (SCS) use, metered-dose inhaler use, and pulse oximetry (PulseOx) were calculated for three patient groups: those admitted prior to order set implementation ('pre-set'); those admitted after implementation but without the order set used ('no set'); and those admitted after implementation with the order set used ('set'). Financial measures of length of stay, total charges, and pharmacy charges were also calculated. Focus groups exploring attitudes about order sets were held with physician users of order sets. Order set patients were significantly more likely to receive SCS and PulseOx than 'pre-set' and 'no set' patients. 'No set' patients did not differ significantly from 'pre-set' patients. No significant differences were found in financial measures. Results from focus groups suggested that order set use would be optimized by promoting order set awareness and maximizing order set quality. These results give further credence to policy-makers' calls for expanded use of CPOE systems with condition-specific order sets to facilitate provision of evidence-based care.
计算机化医师医嘱录入（CPOE）系统中的特定病情医嘱集旨在减少不必要的实践差异，并促进循证医疗实践。本研究定量评估了计算机化医嘱集的使用与小儿住院哮喘治疗护理流程之间的关系，并定性评估了用户对医嘱集使用的态度。研究人群包括2001年11月1日至2003年11月30日期间入住哥伦布儿童医院、初步诊断为哮喘的790例患者。计算了三个患者组全身用糖皮质激素（SCS）的使用、定量吸入器的使用以及脉搏血氧饱和度测定（PulseOx）的比率：医嘱集实施前入院的患者（“预设置组”）；实施后入院但未使用医嘱集的患者（“无医嘱集组”）；以及实施后入院且使用医嘱集的患者（“有医嘱集组”）。还计算了住院时间、总费用和药房费用等财务指标。针对医嘱集的医师用户举行了焦点小组讨论，以探讨他们对医嘱集的态度。“有医嘱集组”患者比“预设置组”和“无医嘱集组”患者更有可能接受SCS和PulseOx检查。“无医嘱集组”患者与“预设置组”患者无显著差异。在财务指标方面未发现显著差异。焦点小组的结果表明，通过提高医嘱集的知晓度和优化医嘱集质量，可以优化医嘱集的使用。这些结果进一步证明了政策制定者呼吁扩大使用带有特定病情医嘱集的CPOE系统以促进循证医疗服务的合理性。
