Lobach D F, Hammond W E
Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Med. 1997 Jan;102(1):89-98. doi: 10.1016/s0002-9343(96)00382-8.
Clinical guidelines are designed to assist in the management of specific diseases; however, these guidelines are often neglected in the delivery of care. The purpose of this study was to determine whether clinician use of an clinical practice guideline would increase in response to having, at the patient visit, a decision support system based on a practice guideline that generates a customized management protocol for the individual patient using data from the patient's electronic medical record.
In a 6-month controlled trial at a primary care clinic, 58 primary care clinicians were randomized to receive either a special encounter form with the computer-generated guideline recommendations or a standard encounter form. The effect of computer-generated advice on clinician behavior was measured as rate of compliance with guideline recommendations. Data from 30 clinicians were analyzed; data from 28 clinicians were excluded because these clinicians did not meet predefined criteria for minimum exposure to diabetic patient care.
Availability of patient management recommendations generated by the decision support system resulted in a two-fold increase in clinician compliance with care guidelines for diabetes mellitus (P = 0.01). Median compliance for the group receiving the recommendations was 32.0% versus 15.6% for the control group.
Decision support based on a clinical practice guideline is an effective tool for assisting clinicians in the management of diabetic patients. This decision support system provides a model for how a clinical practice guideline can be integrated into the care process by computer to assist clinicians in managing a specific disease through helping them comply with care standards. Use of decision support systems based on clinical practice guidelines could ultimately improve the quality of medical care.
临床指南旨在协助特定疾病的管理；然而，在提供护理时这些指南常常被忽视。本研究的目的是确定临床医生对临床实践指南的使用是否会因在患者就诊时拥有一个基于实践指南的决策支持系统而增加，该系统利用患者电子病历中的数据为个体患者生成定制的管理方案。
在一家初级保健诊所进行的为期6个月的对照试验中，58名初级保健临床医生被随机分为两组，一组接受带有计算机生成的指南建议的特殊问诊表格，另一组接受标准问诊表格。计算机生成的建议对临床医生行为的影响以对指南建议的依从率来衡量。分析了30名临床医生的数据；排除了28名临床医生的数据，因为这些临床医生未达到糖尿病患者护理最低接触量的预定义标准。
决策支持系统生成的患者管理建议的可用性使临床医生对糖尿病护理指南的依从性提高了两倍（P = 0.01）。接受建议组的中位依从率为32.0%，而对照组为15.6%。
基于临床实践指南的决策支持是协助临床医生管理糖尿病患者的有效工具。该决策支持系统提供了一个模型，展示了临床实践指南如何通过计算机整合到护理过程中，通过帮助临床医生遵守护理标准来协助他们管理特定疾病。使用基于临床实践指南的决策支持系统最终可能会提高医疗质量。
