Nilasena D S, Lincoln M J, Turner C W, Warner H R, Foerster V A, Williamson J W, Stults B M
Department of Medicine, Salt Lake Veterans Affairs Medical Center, UT.
Proc Annu Symp Comput Appl Med Care. 1994:831-5.
Diabetes mellitus is a chronic condition with several late complications that can be delayed or avoided through proper preventive health care. Although practice guidelines have been established to improve the preventive care in diabetics, dissemination of these guidelines among physicians and educational programs have been only moderately successful in changing physicians' practice patterns. Previous efforts, however, did not utilize computer-generated reminders. We developed a system of computer-generated reminders for diabetic preventive care. We completed an implementation of the system in the outpatient clinics of internal medicine residents at our institution. This paper describes the development and implementation of this system. Our results showed that the system flagged an average of 13 items that deviated from diabetes guideline compliance, out of a possible 21 items per patient. The residents completed encounter forms used by the system for 37% of patients seen during a six month period. Physician users exhibited positive attitudes toward the use of guidelines which they judged improved quality at no additional cost of care. However, the complexity and length of the guideline encounter forms and the additional time demands proved to be significant obstacles to current routine use. Our experience will help to improve the system so that it is more usable and acceptable to physicians, especially in the future as health care increasingly makes use of electronic medical record systems.
糖尿病是一种慢性病，有多种晚期并发症，通过适当的预防性医疗保健可以延缓或避免这些并发症。尽管已经制定了实践指南来改善糖尿病患者的预防性护理，但这些指南在医生中的传播以及教育项目在改变医生的实践模式方面仅取得了一定程度的成功。然而，以前的努力没有利用计算机生成的提醒。我们开发了一个用于糖尿病预防性护理的计算机生成提醒系统。我们在我们机构的内科住院医师门诊完成了该系统的实施。本文描述了该系统的开发和实施。我们的结果表明，该系统平均标记出13项偏离糖尿病指南合规性的项目，每位患者可能有21项。在六个月期间，住院医师为37%的就诊患者填写了该系统使用的会诊表格。医生用户对使用指南表现出积极态度，他们认为这在不增加护理成本的情况下提高了质量。然而，指南会诊表格的复杂性和长度以及额外的时间需求被证明是当前常规使用的重大障碍。我们的经验将有助于改进该系统，使其对医生更易于使用和接受，特别是在未来医疗保健越来越多地使用电子病历系统的情况下。
