Lobach D F, Hammond W E
Department of Biomedical Engineering, Duke University, Durham, N.C.
Proc Annu Symp Comput Appl Med Care. 1994:787-91.
Disease-specific standards for directing patient management are becoming increasingly important. These standards, however, are often not followed because they are not sufficiently integrated into the clinical care setting. In this study we describe the development and evaluation of a Computer-Assisted Management Protocol (CAMP) of care guidelines for diabetes mellitus. While other studies have shown improved compliance with rule-based reminders, the CAMP customizes disease-specific care guidelines to individual patients over time. We evaluated the effect of the CAMP on compliance with guidelines in a prospective, randomized controlled study. The study was performed at a family practice clinic where much of the patient record is maintained electronically on The Medical Record (TMR). The management protocol was developed from standards published by the American Diabetes Association. Fifty-eight providers were randomized to either receive or not receive the CAMP for diabetes. Compliance with standards was assessed by chart audits of all encounters with diabetic patients during the study interval. The following conclusion was made: the Computer-Assisted Management Protocol resulted in a statistically significant improvement in compliance with diabetes care standards.
指导患者管理的疾病特异性标准正变得越来越重要。然而,这些标准常常未被遵循,因为它们没有充分融入临床护理环境。在本研究中,我们描述了一种糖尿病护理指南的计算机辅助管理协议(CAMP)的开发与评估。虽然其他研究表明基于规则的提醒可提高依从性,但CAMP会随着时间推移为个体患者定制疾病特异性护理指南。我们在一项前瞻性随机对照研究中评估了CAMP对指南依从性的影响。该研究在一家家庭医疗诊所进行,那里大部分患者记录以电子方式保存在《病历》(TMR)中。管理协议是根据美国糖尿病协会发布的标准制定的。58名医护人员被随机分为接受或不接受糖尿病CAMP的两组。通过对研究期间与糖尿病患者的所有诊疗记录进行图表审核来评估对标准的依从性。得出了以下结论:计算机辅助管理协议使糖尿病护理标准的依从性在统计学上有显著提高。