Goethe J W, Schwartz H I, Szarek B L
Burlingame Center for Psychiatric Research and Education, Institute of Living, Hartford, USA.
Conn Med. 1997 Sep;61(9):553-8.
Physician adherence to established practice standards has become an important national issue. Despite the proliferation of formal standards of practice, there is little evidence that the mere availability of guidelines results in changes in physician practices. This paper presents the results of a study of the effectiveness of a computerized monitoring and notification system in increasing physician compliance with treatment guidelines.
This study prospectively compared medical staff practices in two one-year periods utilizing a computer system which tabulated noncompliance and provided reminders.
Overall, there was a statistically-significant decrease in the number of alerts issued in year two compared to year one; alerts were issued on 15% vs 29% of all patients (P < .001). The average number of alerts per patient decreased to .20 from .41.
The study results indicate that a clinical decision support system such as that described can improve adherence to treatment guidelines.
医生对既定实践标准的遵循已成为一个重要的全国性问题。尽管正式的实践标准大量涌现，但几乎没有证据表明仅仅提供指南就能导致医生实践的改变。本文介绍了一项关于计算机化监测和通知系统在提高医生对治疗指南依从性方面有效性的研究结果。
本研究前瞻性地比较了两个为期一年期间的医务人员实践情况，使用一个能将不依从情况制成表格并提供提醒的计算机系统。
总体而言，与第一年相比，第二年发出的警报数量有统计学意义的下降；在所有患者中发出警报的比例从29%降至15%（P <.001）。每位患者的平均警报数量从0.41降至0.20。
研究结果表明，如所述的临床决策支持系统可以提高对治疗指南的依从性。
