Department of Medicine; Faculty of Medicine, University of Toronto, Ont, Canada.
Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Am J Med. 2021 Aug;134(8):952-962.e4. doi: 10.1016/j.amjmed.2021.03.004. Epub 2021 Mar 26.
Optimal strategies for integration of clinical practice guidelines into electronic medical records and its impact on processes of care and clinical outcomes in diabetic patients are not well understood. A systematic review of CINAHL, MEDLINE, PubMed, and Cochrane Library databases in August 2016, November 2017, and June 2020 was conducted. Studies investigating integration of diabetes guidelines into ambulatory care electronic medical records reporting quantitative results were included. After screening 15,783 records, 21 articles were included. Lipid and blood pressure control consistently improved with guideline integration, but A1c control remained equivocal. Electronic guideline integration improved microvascular complication screening, vaccination, and documentation of cardiovascular risk factors, while medication prescription and blood pressure, lipid, and A1c documentation did not improve. Studies employing a combination of electronic record intervention strategies were associated with improvement in monitoring and attainment of guideline and screening targets. Thus, strategies employing combinations of interventions to incorporate guidelines into electronic records may improve processes of care and some clinical outcomes.
将临床实践指南整合到电子病历中以及其对糖尿病患者的护理流程和临床结局的影响的最佳策略尚不清楚。2016 年 8 月、2017 年 11 月和 2020 年 6 月对 CINAHL、MEDLINE、PubMed 和 Cochrane Library 数据库进行了系统评价。纳入了调查将糖尿病指南整合到门诊护理电子病历中并报告定量结果的研究。经过筛选 15783 条记录，纳入了 21 篇文章。血脂和血压控制随着指南的整合而持续改善，但 A1c 控制仍存在争议。电子指南整合改善了微血管并发症筛查、疫苗接种和心血管危险因素的记录，而药物处方以及血压、血脂和 A1c 的记录并未改善。采用电子病历干预策略组合的研究与监测和达到指南和筛查目标的改善相关。因此，采用将指南整合到电子记录中的干预措施组合的策略可能会改善护理流程和一些临床结局。
