Capobussi Matteo, Banzi Rita, Moja Lorenzo, Bonovas Stefanos, González-Lorenzo Marien, Liberati Elisa Giulia, Polo Friz Hernan, Nanni Oriana, Mangia Massimo, Ruggiero Francesca
Scuola di Specializzazione in Igiene e Medicina Preventiva, Università di Milano.
IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano.
Recenti Prog Med. 2016 Nov;107(11):589-591. doi: 10.1701/2484.25970.
One of the aims of Evidence-Based Medicine is to improve quality and appropriateness of care by the expedition of the knowledge transfer process. Computerized Decision Support Systems (CDSSs) are computer programs that provide alerts to the prescribing doctor directly at the moment of medical examination. In fact, alerts are integrated within the single patient electronic health record. CDSS based on the best available and updated evidence and guidelines may be an efficient tool to facilitate the transfer of the latest results from clinical research directly at the bedside, thus supporting decision-making.
The CODES (COmputerized DEcision Support) trial is a research program funded by the Italian Ministry of Health and the Lombardy Region. It aims to evaluate the feasibility of the implementation of a CDSS at the hospital level and to assess its efficacy in daily clinical practice.
The CODES project includes two pragmatic RCTs testing a CDSS (i.e. the EBMeDS - MediDSS) in two large Italian hospitals: the first is a general hospital in Vimercate (Lombardy), the second is an oncologic research center in Meldola (Emilia Romagna). The CDSS supports a full spectrum of decisions: therapy, drug interactions, diagnosis, and management of health care services are covered by a hundreds of reminders. However only few reminders are activated per patient, highlighting crucial problems in the delivery of high-quality care. The two trials have similar design and primary outcome, the rate at which alerts detected by the software are resolved by a decision of the clinicians. The project also includes the assessment of barriers and facilitators in the adoption of these new technologies by hospital staff members and the retrospective evaluation of the repeated risks in prescription habits.
The trials are ongoing and currently more than 10,000 patients have been randomized. The qualitative analysis revealed a progressive shift in the perception of the tool. Doctors are now seeing it as a trusted second opinion, available 24/7, which is tailored to the needs of the patient. The retrospective analysis showed the opportunity to achieve a better healthcare quality through an active risk management. Aggregating data from whole hospitals emerge rare drug interactions that otherwise would not be recognizable.
CDSS are promising tools to support clinicians in everyday practice. They can be used as a real time app or to perform retrospective analyses. These data can provide unique resources to hospital management.
循证医学的目标之一是通过加快知识传播过程来提高医疗质量和合理性。计算机化决策支持系统（CDSS）是在医疗检查时直接向开处方医生发出警报的计算机程序。实际上，警报被整合到单个患者的电子健康记录中。基于最佳可得和最新证据及指南的CDSS可能是一种有效的工具，可直接在床边促进临床研究最新成果的传播，从而支持决策制定。
CODES（计算机化决策支持）试验是一项由意大利卫生部和伦巴第大区资助的研究项目。其目的是评估在医院层面实施CDSS的可行性，并评估其在日常临床实践中的疗效。
CODES项目包括两项实用随机对照试验，在意大利两家大型医院测试一种CDSS（即EBMeDS - MediDSS）：第一家是位于维梅尔卡特（伦巴第）的综合医院，第二家是位于梅尔多拉（艾米利亚 - 罗马涅）的肿瘤研究中心。该CDSS支持全方位决策：治疗、药物相互作用、诊断以及医疗服务管理涵盖数百条提醒。然而，每位患者仅激活少数提醒，凸显了提供高质量医疗服务中的关键问题。这两项试验具有相似的设计和主要结局，即软件检测到的警报由临床医生决策解决的速率。该项目还包括评估医院工作人员采用这些新技术的障碍和促进因素，以及对处方习惯中反复出现风险的回顾性评估。
试验正在进行中，目前已有超过10000名患者被随机分组。定性分析显示对该工具的认知有逐步转变。医生现在将其视为随时可用的、值得信赖的第二意见，且是根据患者需求量身定制的。回顾性分析表明通过积极的风险管理有机会实现更好的医疗质量。汇总来自整个医院的数据发现了罕见的药物相互作用，否则这些相互作用将无法识别。
CDSS是支持临床医生日常实践的有前景的工具。它们可作为实时应用程序使用或进行回顾性分析。这些数据可为医院管理提供独特资源。
