J Am Med Inform Assoc - A framework for evaluating the appropriateness of clinical decision support alerts and responses.

Tópicos

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Resumo

JECTIVE: Alerting systems, a type of clinical decision support, are increasingly prevalent in healthcare, yet few studies have concurrently measured the appropriateness of alerts with provider responses to alerts. Recent reports of suboptimal alert system design and implementation highlight the need for better evaluation to inform future designs. The authors present a comprehensive framework for evaluating the clinical appropriateness of synchronous, interruptive medication safety alerts.METHODS: Through literature review and iterative testing, metrics were developed that describe successes, justifiable overrides, provider non-adherence, and unintended adverse consequences of clinical decision support alerts. The framework was validated by applying it to a medication alerting system for patients with acute kidney injury (AKI).RESULTS: Through expert review, the framework assesses each alert episode for appropriateness of the alert display and the necessity and urgency of a clinical response. Primary outcomes of the framework include the false positive alert rate, alert override rate, provider non-adherence rate, and rate of provider response appropriateness. Application of the framework to evaluate an existing AKI medication alerting system provided a more complete understanding of the process outcomes measured in the AKI medication alerting system. The authors confirmed that previous alerts and provider responses were most often appropriate.CONCLUSION: The new evaluation model offers a potentially effective method for assessing the clinical appropriateness of synchronous interruptive medication alerts prior to evaluating patient outcomes in a comparative trial. More work can determine the generalizability of the framework for use in other settings and other alert types.

Resumo Limpo

jectiv alert system type clinic decis support increas preval healthcar yet studi concurr measur appropri alert provid respons alert recent report suboptim alert system design implement highlight need better evalu inform futur design author present comprehens framework evalu clinic appropri synchron interrupt medic safeti alertsmethod literatur review iter test metric develop describ success justifi overrid provid nonadher unintend advers consequ clinic decis support alert framework valid appli medic alert system patient acut kidney injuri akiresult expert review framework assess alert episod appropri alert display necess urgenc clinic respons primari outcom framework includ fals posit alert rate alert overrid rate provid nonadher rate rate provid respons appropri applic framework evalu exist aki medic alert system provid complet understand process outcom measur aki medic alert system author confirm previous alert provid respons often appropriateconclus new evalu model offer potenti effect method assess clinic appropri synchron interrupt medic alert prior evalu patient outcom compar trial work can determin generaliz framework use set alert type

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