电子临床决策支持系统对产前护理工作流程的影响：加纳和坦桑尼亚农村医疗机构中的QUALMAT电子临床决策支持系统
Impact of an electronic clinical decision support system on workflow in antenatal care: the QUALMAT eCDSS in rural health care facilities in Ghana and Tanzania.
作者信息
Mensah Nathan, Sukums Felix, Awine Timothy, Meid Andreas, Williams John, Akweongo Patricia, Kaltschmidt Jens, Haefeli Walter E, Blank Antje
机构信息
Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany; Navrongo Health Research Centre, Navrongo, Ghana.
Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany; Muhimbili University of Health and Allied Sciences (MUHAS), Directorate of Information and Communication Technology, Dar Es Salaam, Tanzania.
出版信息
Glob Health Action. 2015 Jan 27;8:25756. doi: 10.3402/gha.v8.25756. eCollection 2015.
BACKGROUND
The implementation of new technology can interrupt established workflows in health care settings. The Quality of Maternal Care (QUALMAT) project has introduced an electronic clinical decision support system (eCDSS) for antenatal care (ANC) and delivery in rural primary health care facilities in Africa.
OBJECTIVE
This study was carried out to investigate the influence of the QUALMAT eCDSS on the workflow of health care workers in rural primary health care facilities in Ghana and Tanzania.
DESIGN
A direct observation, time-and-motion study on ANC processes was conducted using a structured data sheet with predefined major task categories. The duration and sequence of tasks performed during ANC visits were observed, and changes after the implementation of the eCDSS were analyzed.
RESULTS
In 24 QUALMAT study sites, 214 observations of ANC visits (144 in Ghana, 70 in Tanzania) were carried out at baseline and 148 observations (104 in Ghana, 44 in Tanzania) after the software was implemented in 12 of those sites. The median time spent combined for all centers in both countries to provide ANC at baseline was 6.5 min [interquartile range (IQR) =4.0-10.6]. Although the time spent on ANC increased in Tanzania and Ghana after the eCDSS implementation as compared to baseline, overall there was no significant increase in time used for ANC activities (0.51 min, p=0.06 in Ghana; and 0.54 min, p=0.26 in Tanzania) as compared to the control sites without the eCDSS. The percentage of medical history taking in women who had subsequent examinations increased after eCDSS implementation from 58.2% (39/67) to 95.3% (61/64) p<0.001 in Ghana but not in Tanzania [from 65.4% (17/26) to 71.4% (15/21) p=0.70].
CONCLUSIONS
The QUALMAT eCDSS does not increase the time needed for ANC but partly streamlined workflow at sites in Ghana, showing the potential of such a system to influence quality of care positively.
背景
新技术的实施可能会打断医疗机构已有的工作流程。孕产妇护理质量（QUALMAT）项目在非洲农村初级卫生保健机构引入了用于产前护理（ANC）和分娩的电子临床决策支持系统（eCDSS）。
目的
本研究旨在调查QUALMAT eCDSS对加纳和坦桑尼亚农村初级卫生保健机构医护人员工作流程的影响。
设计
使用带有预定义主要任务类别的结构化数据表，对ANC流程进行直接观察、时间和动作研究。观察了ANC就诊期间执行任务的持续时间和顺序，并分析了eCDSS实施后的变化。
结果
在24个QUALMAT研究地点，基线时进行了214次ANC就诊观察（加纳144次，坦桑尼亚70次），在其中12个地点实施该软件后进行了148次观察（加纳104次，坦桑尼亚44次）。两国所有中心在基线时提供ANC的总用时中位数为6.5分钟[四分位间距（IQR）=4.0 - 10.6]。与基线相比，eCDSS实施后，加纳和坦桑尼亚用于ANC的时间有所增加，但与未使用eCDSS的对照地点相比，ANC活动的总用时没有显著增加（加纳增加0.51分钟，p = 0.06；坦桑尼亚增加0.54分钟，p = 0.26）。在加纳，实施eCDSS后，后续接受检查的女性中进行病史采集的比例从58.2%（39/67）增加到95.3%（61/64），p < 0.001，但在坦桑尼亚没有变化[从65.4%（17/26）增加到71.4%（15/21），p = 0.70]。
结论
QUALMAT eCDSS不会增加ANC所需时间，但在加纳的部分地点部分简化了工作流程，显示出此类系统对积极影响护理质量的潜力。
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