电子健康记录临床决策支持对糖尿病护理的影响：一项随机试验。
Impact of electronic health record clinical decision support on diabetes care: a randomized trial.
机构信息
Health Partners Medical Group, Minneapolis, MN, USA.
出版信息
Ann Fam Med. 2011 Jan-Feb;9(1):12-21. doi: 10.1370/afm.1196.
PURPOSE
We wanted to assess the impact of an electronic health record-based diabetes clinical decision support system on control of hemoglobin A(1c) (glycated hemoglobin), blood pressure, and low-density lipoprotein (LDL) cholesterol levels in adults with diabetes.
METHODS
We conducted a clinic-randomized trial conducted from October 2006 to May 2007 in Minnesota. Included were 11 clinics with 41 consenting primary care physicians and the physicians' 2,556 patients with diabetes. Patients were randomized either to receive or not to receive an electronic health record (EHR)-based clinical decision support system designed to improve care for those patients whose hemoglobin A(1c), blood pressure, or LDL cholesterol levels were higher than goal at any office visit. Analysis used general and generalized linear mixed models with repeated time measurements to accommodate the nested data structure.
RESULTS
The intervention group physicians used the EHR-based decision support system at 62.6% of all office visits made by adults with diabetes. The intervention group diabetes patients had significantly better hemoglobin A(1c) (intervention effect -0.26%; 95% confidence interval, -0.06% to -0.47%; P=.01), and better maintenance of systolic blood pressure control (80.2% vs 75.1%, P=.03) and borderline better maintenance of diastolic blood pressure control (85.6% vs 81.7%, P =.07), but not improved low-density lipoprotein cholesterol levels (P = .62) than patients of physicians randomized to the control arm of the study. Among intervention group physicians, 94% were satisfied or very satisfied with the intervention, and moderate use of the support system persisted for more than 1 year after feedback and incentives to encourage its use were discontinued.
CONCLUSIONS
EHR-based diabetes clinical decision support significantly improved glucose control and some aspects of blood pressure control in adults with type 2 diabetes.
目的
我们旨在评估基于电子健康记录的糖尿病临床决策支持系统对控制糖化血红蛋白（HbA1c）、血压和低密度脂蛋白（LDL）胆固醇水平的影响，对象为患有糖尿病的成年人。
方法
我们开展了一项诊所随机试验，于 2006 年 10 月至 2007 年 5 月在明尼苏达州进行。共纳入 11 家诊所的 41 名同意参加的初级保健医生及其 2556 名糖尿病患者。患者被随机分为接受或不接受基于电子健康记录（EHR）的临床决策支持系统，该系统旨在改善那些在每次就诊时 HbA1c、血压或 LDL 胆固醇水平高于目标的患者的治疗。分析采用广义和广义线性混合模型进行，通过重复时间测量来适应嵌套数据结构。
结果
在所有患有糖尿病的成年人就诊中，干预组医生使用基于 EHR 的决策支持系统的比例为 62.6%。干预组糖尿病患者的 HbA1c 显著改善（干预效果-0.26%；95%置信区间，-0.06%至-0.47%；P=.01），收缩压控制的维持情况更好（80.2%比 75.1%，P=.03），舒张压控制的维持情况略有改善（85.6%比 81.7%，P=.07），但 LDL 胆固醇水平没有改善（P =.62），与被随机分配到研究对照组的患者相比。在干预组医生中，94%对干预措施感到满意或非常满意，并且在停止反馈和激励以鼓励使用该支持系统后，该系统的中度使用持续了 1 年以上。
结论
基于 EHR 的糖尿病临床决策支持系统显著改善了 2 型糖尿病成年患者的血糖控制和某些方面的血压控制。
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