Int J Med Inform - What, if all alerts were specific - estimating the potential impact on drug interaction alert burden.

Tópicos

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Resumo

RPOSE: Clinical decision support systems (CDSS) may potentially improve prescribing quality, but are subject to poor user acceptance. Reasons for alert overriding have been identified and counterstrategies have been suggested; however, poor alert specificity, a prominent reason of alert overriding, has not been well addressed. This paper aims at structuring modulators that determine alert specificity and estimating their quantitative impact on alert burden.METHODS: We developed and summarized optimizing strategies to guarantee the specificity of alerts and applied them to a set of 100 critical and frequent drug interaction (DDI) alerts. Hence, DDI alerts were classified as dynamic, i.e. potentially sensitive to prescription-, co-medication-, or patient-related factors that would change alert severity or render the alert inappropriate compared to static, i.e. always applicable alerts not modulated by cofactors.RESULTS: Within the subset of 100 critical DDI alerts, only 10 alerts were considered as static and for 7 alerts, relevant factors are not generally available in today's patient charts or their consideration would not impact alert severity. The vast majority, i.e. 83 alerts, might require a decrease in alert severity due to factors related to the prescription (N=13), the co-medication (N=11), individual patient data (N=36), or combinations of them (N=23). Patient-related factors consisted mainly of three lab values, i.e. renal function, potassium, and therapeutic drug monitoring results.CONCLUSION: This paper outlines how promising the refinement of knowledge bases is in order to increase specificity and decrease alert burden and suggests how to structure knowledge bases to refine DDI alerting.

Resumo Limpo

rpose clinic decis support system cdss may potenti improv prescrib qualiti subject poor user accept reason alert overrid identifi counterstrategi suggest howev poor alert specif promin reason alert overrid well address paper aim structur modul determin alert specif estim quantit impact alert burdenmethod develop summar optim strategi guarante specif alert appli set critic frequent drug interact ddi alert henc ddi alert classifi dynam ie potenti sensit prescript comed patientrel factor chang alert sever render alert inappropri compar static ie alway applic alert modul cofactorsresult within subset critic ddi alert alert consid static alert relev factor general avail today patient chart consider impact alert sever vast major ie alert might requir decreas alert sever due factor relat prescript n comed n individu patient data n combin n patientrel factor consist main three lab valu ie renal function potassium therapeut drug monitor resultsconclus paper outlin promis refin knowledg base order increas specif decreas alert burden suggest structur knowledg base refin ddi alert

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