Séroussi B, Falcoff H, Sauquet D, Julien J, Bouaud J
Université Paris 6, UFR de Médecine, Paris, France; AP-HP, Hôpital Tenon, Département de Santé Publique, Paris, France; Université Paris 13, UFR SMBH, LIM&BIO, Bobigny, France.
AMIA Annu Symp Proc. 2010 Nov 13;2010:737-41.
Clinical decision support systems (CDSSs) have the potential to increase guideline adherence, but factors of success are not yet understood. ASTI guiding mode (ASTI-GM) is an on-demand guideline-based CDSS where the user navigates in a knowledge base to get the best treatment for a given patient. We conducted a web-based evaluation of ASTI-GM, carried out as a before-after study, where general practitioners (GPs) were asked to solve 5 clinical cases, first without ASTI-GM, then using the system. Of the 136 GPs that resolved the case on the management of hypertension, compliance with best practices increased from 69.1% to 80.9% with ASTI-GM. When the navigation matched the set of patient parameters described in the clinical case, the increase was even higher and reached 92.9%. E-iatrogenesis has been measured at 19.1%, with 5.1% of commission errors, 8.1% of negative reactance, and 5.9% of neutral reactance. Role of physicians' reactance in noncompliance with guideline-based CDSSs should be further investigated.
临床决策支持系统（CDSSs）有提高指南依从性的潜力，但成功的因素尚未明确。ASTI指导模式（ASTI-GM）是一种基于按需指南的CDSS，用户可在知识库中进行导航，为特定患者获取最佳治疗方案。我们对ASTI-GM进行了基于网络的评估，采用前后对照研究，要求全科医生（GPs）解决5个临床病例，先是在没有ASTI-GM的情况下，然后使用该系统。在136名解决了高血压管理病例的全科医生中，使用ASTI-GM时，最佳实践的依从率从69.1%提高到了80.9%。当导航与临床病例中描述的患者参数集匹配时，提高幅度更大，达到了92.9%。电子医源性损伤的发生率为19.1%，其中委托错误为5.1%，负反应为8.1%，中性反应为5.9%。医生的反应在不遵守基于指南的CDSSs中的作用应进一步研究。
