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决策支持工具:挖掘改善医疗质量的潜力。

Decision Support Tools: Realizing the Potential to Improve Quality of Care.

机构信息

Division of Cardiology and Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.

Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute of Alberta, O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.

出版信息

Can J Cardiol. 2018 Jul;34(7):821-826. doi: 10.1016/j.cjca.2018.02.029. Epub 2018 Mar 3.

Abstract

Delivering evidence-based, personalized care that engages patients requires profound changes in the structure, process, and organization of care, along with revised incentives to support such changes. Health care providers must absorb and apply a vast, usually overwhelming, amount of scientific information to provide high-quality patient care. Accordingly, care remains inconsistent, with unintentional adverse consequences. Decision support tools can provide patient-specific assessments that support clinical decisions, improve prescribing practices, reduce medication errors, improve the delivery of primary as well as secondary prevention, and improve adherence to standards of care. Decision support tools are created using an individual patient's genetic, sociodemographic, and clinical characteristics to improve the delivery of precise, personalized care. Implementation requires ease of use for busy clinicians; uptake improves with active education, and gradual adoption of a tool integrated into care processes without disrupting clinical work flow. As health care systems continue to evolve and computerized support increases, increased implementation of decision support tools that are provided automatically as part of usual work flow, with clinically actionable recommendations at the point of care, requiring accountability for deviations from recommended therapy, represent an important opportunity to enhance quality of care by tailoring treatment to risk, improving the consistency of health care delivery, increasing patient knowledge and engagement, and avoiding specific therapeutic interventions in patients who will receive no benefit. However, successful implementation also requires strategies to engage providers in accepting and using these tools to improve care.

摘要

提供循证、个性化的医疗服务需要对医疗服务的结构、流程和组织进行深刻变革,并调整激励机制以支持这些变革。医疗保健提供者必须吸收和应用大量的科学信息,为患者提供高质量的医疗服务。因此,医疗服务仍然不一致,并且会产生非故意的不良后果。决策支持工具可以提供针对特定患者的评估,支持临床决策,改善处方实践,减少药物错误,改善初级和二级预防的实施,并提高对护理标准的依从性。决策支持工具是使用个体患者的遗传、社会人口学和临床特征创建的,以改善精确、个性化护理的实施。实施需要方便忙碌的临床医生使用;通过积极的教育、逐步采用集成到护理流程中的工具,而不中断临床工作流程,可以提高采用率。随着医疗保健系统的不断发展和计算机支持的增加,更多地实施决策支持工具,这些工具作为常规工作流程的一部分自动提供,并在护理点提供临床可操作的建议,需要对偏离推荐治疗的情况负责,这代表了一个重要的机会,可以通过根据风险定制治疗、提高医疗服务一致性、增加患者知识和参与度以及避免对无获益患者进行特定治疗干预来提高护理质量。然而,成功实施还需要制定策略,让提供者接受并使用这些工具来改善护理。

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