Centre de Recherche des Cordeliers, INSERM, U872 Eq, 20, Paris, F-75006 France.
BMC Health Serv Res. 2010 Mar 19;10:70. doi: 10.1186/1472-6963-10-70.
Laboratory testing is frequently unnecessary, particularly repetitive testing. Among the interventions proposed to reduce unnecessary testing, Computerized Decision Support Systems (CDSS) have been shown to be effective, but their impact depends on their technical characteristics. The objective of the study was to evaluate the impact of a Serology-CDSS providing point of care reminders of previous existing serology results, embedded in a Computerized Physician Order Entry at a university teaching hospital in Paris, France.
A CDSS was implemented in the Cardiovascular Surgery department of the hospital in order to decrease inappropriate repetitions of viral serology tests (HBV).A time series analysis was performed to assess the impact of the alert on physicians' practices. The study took place between January 2004 and December 2007. The primary outcome was the proportion of unnecessarily repeated HBs antigen tests over the periods of the study. A test was considered unnecessary when it was ordered within 90 days after a previous test for the same patient. A secondary outcome was the proportion of potentially unnecessary HBs antigen test orders cancelled after an alert display.
In the pre-intervention period, 3,480 viral serology tests were ordered, of which 538 (15.5%) were unnecessarily repeated. During the intervention period, of the 2,095 HBs antigen tests performed, 330 unnecessary repetitions (15.8%) were observed. Before the intervention, the mean proportion of unnecessarily repeated HBs antigen tests increased by 0.4% per month (absolute increase, 95% CI 0.2% to 0.6%, p < 0.001). After the intervention, a significant trend change occurred, with a monthly difference estimated at -0.4% (95% CI -0.7% to -0.1%, p = 0.02) resulting in a stable proportion of unnecessarily repeated HBs antigen tests. A total of 380 unnecessary tests were ordered among 500 alerts displayed (compliance rate 24%).
The proportion of unnecessarily repeated tests immediately dropped after CDSS implementation and remained stable, contrasting with the significant continuous increase observed before. The compliance rate confirmed the effect of the alerts. It is necessary to continue experimentation with dedicated systems in order to improve understanding of the diversity of CDSS and their impact on clinical practice.
实验室检测通常是不必要的，尤其是重复性检测。在提出的减少不必要检测的干预措施中，计算机决策支持系统（CDSS）已被证明是有效的，但它们的效果取决于其技术特点。本研究的目的是评估一种在法国巴黎一所教学医院的心血管外科部门中提供即时护理的血清学-CDSS 提醒先前存在的血清学结果的影响，该系统嵌入计算机化医嘱录入系统中。
为了减少乙型肝炎病毒（HBV）血清学检测的不当重复，在医院的心血管外科部门实施了 CDSS。采用时间序列分析评估该警报对医生实践的影响。研究于 2004 年 1 月至 2007 年 12 月进行。主要结局是在研究期间不必要重复 HBs 抗原检测的比例。当同一患者在 90 天内再次进行检测时，即认为该检测是不必要的。次要结局是在警报显示后取消潜在不必要的 HBs 抗原检测订单的比例。
在干预前阶段，共进行了 3480 项病毒血清学检测，其中 538 项（15.5%）为不必要的重复检测。在干预期间，共进行了 2095 项 HBs 抗原检测，观察到 330 次不必要的重复检测（15.8%）。在干预前，不必要的 HBs 抗原检测的平均重复比例每月增加 0.4%（绝对增加，95%CI 0.2%至 0.6%，p < 0.001）。干预后，趋势发生显著变化，每月差异估计为-0.4%（95%CI-0.7%至-0.1%，p = 0.02），导致不必要的 HBs 抗原检测比例稳定。在显示的 500 次警报中，共下达了 380 次不必要的检测（遵医嘱率为 24%）。
CDSS 实施后，不必要检测的比例立即下降且保持稳定，与干预前观察到的持续显著增加形成对比。遵医嘱率证实了警报的效果。有必要继续使用专用系统进行试验，以提高对 CDSS 的多样性及其对临床实践的影响的理解。
