电子临床护理路径框架：一种用于创建在线复杂临床护理路径的新型结构及其在性传播感染管理中的应用。
The eClinical Care Pathway Framework: a novel structure for creation of online complex clinical care pathways and its application in the management of sexually transmitted infections.
作者信息
Gibbs Jo, Sutcliffe Lorna J, Gkatzidou Voula, Hone Kate, Ashcroft Richard E, Harding-Esch Emma M, Lowndes Catherine M, Sadiq S Tariq, Sonnenberg Pam, Estcourt Claudia S
机构信息
Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, UK.
出版信息
BMC Med Inform Decis Mak. 2016 Jul 22;16:98. doi: 10.1186/s12911-016-0338-8.
BACKGROUND
Despite considerable international eHealth impetus, there is no guidance on the development of online clinical care pathways. Advances in diagnostics now enable self-testing with home diagnosis, to which comprehensive online clinical care could be linked, facilitating completely self-directed, remote care. We describe a new framework for developing complex online clinical care pathways and its application to clinical management of people with genital chlamydia infection, the commonest sexually transmitted infection (STI) in England.
METHODS
Using the existing evidence-base, guidelines and examples from contemporary clinical practice, we developed the eClinical Care Pathway Framework, a nine-step iterative process. Step 1: define the aims of the online pathway; Step 2: define the functional units; Step 3: draft the clinical consultation; Step 4: expert review; Step 5: cognitive testing; Step 6: user-centred interface testing; Step 7: specification development; Step 8: software testing, usability testing and further comprehension testing; Step 9: piloting. We then applied the Framework to create a chlamydia online clinical care pathway (Online Chlamydia Pathway).
RESULTS
Use of the Framework elucidated content and structure of the care pathway and identified the need for significant changes in sequences of care (Traditional: history, diagnosis, information versus Online: diagnosis, information, history) and prescribing safety assessment. The Framework met the needs of complex STI management and enabled development of a multi-faceted, fully-automated consultation.
CONCLUSION
The Framework provides a comprehensive structure on which complex online care pathways such as those needed for STI management, which involve clinical services, public health surveillance functions and third party (sexual partner) management, can be developed to meet national clinical and public health standards. The Online Chlamydia Pathway's standardised method of collecting data on demographics and sexual behaviour, with potential for interoperability with surveillance systems, could be a powerful tool for public health and clinical management.
背景
尽管国际上对电子健康投入了大量精力，但对于在线临床护理路径的开发尚无指导意见。目前诊断技术的进步使得家庭诊断自我检测成为可能，全面的在线临床护理可与之相联系，从而实现完全自主的远程护理。我们描述了一个用于开发复杂在线临床护理路径的新框架及其在生殖器衣原体感染患者临床管理中的应用，生殖器衣原体感染是英国最常见的性传播感染（STI）。
方法
利用现有证据基础、指南以及当代临床实践中的实例，我们开发了电子临床护理路径框架，这是一个九步迭代过程。第一步：定义在线路径的目标；第二步：定义功能单元；第三步：起草临床会诊内容；第四步：专家评审；第五步：认知测试；第六步：以用户为中心的界面测试；第七步：规范制定；第八步：软件测试、可用性测试及进一步的理解测试；第九步：试点。然后我们应用该框架创建了衣原体在线临床护理路径（在线衣原体路径）。
结果
该框架的使用阐明了护理路径的内容和结构，并确定了护理顺序（传统方式：病史、诊断、信息；在线方式：诊断、信息、病史）以及处方安全评估方面进行重大改变的必要性。该框架满足了复杂性传播感染管理的需求，并促成了一个多方面、全自动会诊的开发。
结论
该框架提供了一个全面的结构，在此基础上可以开发诸如性传播感染管理所需的复杂在线护理路径，这些路径涉及临床服务、公共卫生监测功能以及第三方（性伴侣）管理，以符合国家临床和公共卫生标准。在线衣原体路径收集人口统计学和性行为数据的标准化方法，以及与监测系统互操作的潜力，可能成为公共卫生和临床管理的有力工具。
Zotero 插件