Int J Med Inform - Effects of two different levels of computerized decision support on blood glucose regulation in critically ill patients.

Tópicos

{ clinic(1479) use(1117) guidelin(835) }
{ time(1939) patient(1703) rate(768) }
{ medic(1828) order(1363) alert(1069) }
{ sampl(1606) size(1419) use(1276) }
{ patient(2315) diseas(1263) diabet(1191) }
{ treatment(1704) effect(941) patient(846) }
{ system(1976) rule(880) can(841) }
{ group(2977) signific(1463) compar(1072) }
{ motion(1329) object(1292) video(1091) }
{ ehr(2073) health(1662) electron(1139) }
{ first(2504) two(1366) second(1323) }
{ use(2086) technolog(871) perceiv(783) }
{ howev(809) still(633) remain(590) }
{ blood(1257) pressur(1144) flow(957) }
{ patient(2837) hospit(1953) medic(668) }
{ measur(2081) correl(1212) valu(896) }
{ general(901) number(790) one(736) }
{ import(1318) role(1303) understand(862) }
{ studi(1119) effect(1106) posit(819) }
{ research(1218) medic(880) student(794) }
{ can(981) present(881) function(850) }
{ model(3404) distribut(989) bayesian(671) }
{ can(774) often(719) complex(702) }
{ data(1737) use(1416) pattern(1282) }
{ network(2748) neural(1063) input(814) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ method(1557) propos(1049) approach(1037) }
{ method(984) reconstruct(947) comput(926) }
{ model(2341) predict(2261) use(1141) }
{ data(2317) use(1299) case(1017) }
{ intervent(3218) particip(2042) group(1664) }
{ patient(1821) servic(1111) care(1106) }
{ structur(1116) can(940) graph(676) }
{ high(1669) rate(1365) level(1280) }
{ drug(1928) target(777) effect(648) }
{ detect(2391) sensit(1101) algorithm(908) }
{ imag(1947) propos(1133) code(1026) }
{ inform(2794) health(2639) internet(1427) }
{ imag(1057) registr(996) error(939) }
{ bind(1733) structur(1185) ligand(1036) }
{ sequenc(1873) structur(1644) protein(1328) }
{ method(1219) similar(1157) match(930) }
{ featur(3375) classif(2383) classifi(1994) }
{ imag(2830) propos(1344) filter(1198) }
{ imag(2675) segment(2577) method(1081) }
{ take(945) account(800) differ(722) }
{ studi(2440) review(1878) systemat(933) }
{ assess(1506) score(1403) qualiti(1306) }
{ framework(1458) process(801) describ(734) }
{ problem(2511) optim(1539) algorithm(950) }
{ error(1145) method(1030) estim(1020) }
{ chang(1828) time(1643) increas(1301) }
{ learn(2355) train(1041) set(1003) }
{ concept(1167) ontolog(924) domain(897) }
{ algorithm(1844) comput(1787) effici(935) }
{ extract(1171) text(1153) clinic(932) }
{ data(1714) softwar(1251) tool(1186) }
{ design(1359) user(1324) use(1319) }
{ control(1307) perform(991) simul(935) }
{ model(2220) cell(1177) simul(1124) }
{ care(1570) inform(1187) nurs(1089) }
{ search(2224) databas(1162) retriev(909) }
{ featur(1941) imag(1645) propos(1176) }
{ case(1353) use(1143) diagnosi(1136) }
{ data(3963) clinic(1234) research(1004) }
{ studi(1410) differ(1259) use(1210) }
{ risk(3053) factor(974) diseas(938) }
{ perform(999) metric(946) measur(919) }
{ research(1085) discuss(1038) issu(1018) }
{ system(1050) medic(1026) inform(1018) }
{ visual(1396) interact(850) tool(830) }
{ compound(1573) activ(1297) structur(1058) }
{ perform(1367) use(1326) method(1137) }
{ spatial(1525) area(1432) region(1030) }
{ record(1888) medic(1808) patient(1693) }
{ health(3367) inform(1360) care(1135) }
{ model(3480) simul(1196) paramet(876) }
{ monitor(1329) mobil(1314) devic(1160) }
{ state(1844) use(1261) util(961) }
{ model(2656) set(1616) predict(1553) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
{ cost(1906) reduc(1198) effect(832) }
{ gene(2352) biolog(1181) express(1162) }
{ data(3008) multipl(1320) sourc(1022) }
{ activ(1138) subject(705) human(624) }
{ analysi(2126) use(1163) compon(1037) }
{ health(1844) social(1437) communiti(874) }
{ cancer(2502) breast(956) screen(824) }
{ use(976) code(926) identifi(902) }
{ use(1733) differ(960) four(931) }
{ result(1111) use(1088) new(759) }
{ implement(1333) system(1263) develop(1122) }
{ survey(1388) particip(1329) question(1065) }
{ estim(2440) model(1874) function(577) }
{ decis(3086) make(1611) patient(1517) }
{ process(1125) use(805) approach(778) }
{ activ(1452) weight(1219) physic(1104) }
{ method(1969) cluster(1462) data(1082) }
{ method(2212) result(1239) propos(1039) }

Resumo

TRODUCTION: Although the use of computerized decision support systems (CDSS) in glucose control in the ICU has been reported, little is known about the effect of the systems' operating modes on the quality of glucose control. The objective of this study was to evaluate the effect of providing patient-specific and patient non-specific computerized advice on timing of blood glucose level (BGL) measurements. Our hypothesis was that both levels of support would be effective for improving the quality of glucose regulation and safety, with patient specific advice being the most effective strategy.PATIENTS AND METHODS: A prospective study was performed in a 30-bed mixed medical-surgical intensive care unit (ICU) of a university hospital. In phase 1 the CDSS provided non-specific advice and thereafter, in phase 2, the system provided specific advice on timing of BGL measurements. The primary outcome measure was delay in BGL measurements before and after the two levels of support. Secondary endpoints were sampling frequency, mean BGL, BGL within pre-defined targets, time to capture target, incidences of severe hypoglycemia and hyperglycemia. These indicators were analyzed over the course of time using Statistical Control Charts. The analysis was restricted to patients with at least two blood glucose measurements.RESULTS: Data of 3934 patient admissions were evaluated, which corresponded to 119,116 BGL measurements. The BGL sampling interval, delays in BG sampling, and percentage of hypoglycemia all decreased after introducing either of the two levels of decision support. The effect was however larger for the patient specific CDSS. Mean BGL, time to capture target, hyperglycemia index, percentage of hyperglycemia events and "in range" measurements remained unchanged and stable after introducing both patient non-specific and patient specific decision support.CONCLUSION: Adherence to protocol sampling rules increased by using decision support with a larger effect at the patient specific level. This led to a decrease in the percentage of hypoglycemia events and improved safety. The use of the CDSS at both levels, however, did not improve the quality of glucose control as measured by our indicators. More research is needed to investigate whether other socio-technical factors are in play.

Resumo Limpo

troduct although use computer decis support system cdss glucos control icu report littl known effect system oper mode qualiti glucos control object studi evalu effect provid patientspecif patient nonspecif computer advic time blood glucos level bgl measur hypothesi level support effect improv qualiti glucos regul safeti patient specif advic effect strategypati method prospect studi perform bed mix medicalsurg intens care unit icu univers hospit phase cdss provid nonspecif advic thereaft phase system provid specif advic time bgl measur primari outcom measur delay bgl measur two level support secondari endpoint sampl frequenc mean bgl bgl within predefin target time captur target incid sever hypoglycemia hyperglycemia indic analyz cours time use statist control chart analysi restrict patient least two blood glucos measurementsresult data patient admiss evalu correspond bgl measur bgl sampl interv delay bg sampl percentag hypoglycemia decreas introduc either two level decis support effect howev larger patient specif cdss mean bgl time captur target hyperglycemia index percentag hyperglycemia event rang measur remain unchang stabl introduc patient nonspecif patient specif decis supportconclus adher protocol sampl rule increas use decis support larger effect patient specif level led decreas percentag hypoglycemia event improv safeti use cdss level howev improv qualiti glucos control measur indic research need investig whether sociotechn factor play

Resumos Similares

Appl Clin Inform - The association between use of a clinical decision support tool and adherence to monitoring for medication-laboratory guidelines in the ambulatory setting. ( 0,761552695175421 )
BMC Med Inform Decis Mak - How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines. ( 0,651860889000233 )
Appl Clin Inform - A Computerized Alert Screening for Severe Sepsis in Emergency Department Patients Increases Lactate Testing but does not Improve Inpatient Mortality. ( 0,62869728504422 )
Telemed J E Health - Robotic telepresence versus standardly supervised stroke alert team assessments. ( 0,627047832168843 )
Healthc (Amst) - Effects of implementing a protocol for arterial blood gas use on ordering practices and diagnostic yield. ( 0,626094155459152 )
Healthc (Amst) - Time spent with patients by physicians, nurse practitioners, and physician assistants in community health centers, 2006-2010. ( 0,626077871813123 )
J Telemed Telecare - Costs and benefits of tele-endoscopy clinics in a remote location. ( 0,600357660268401 )
Methods Inf Med - Appropriateness of ICD-coded diagnostic inpatient hospital discharge data for medical practice assessment. A systematic review. ( 0,59169970446654 )
J. Med. Internet Res. - Feasibility of a wiki as a participatory tool for patients in clinical guideline development. ( 0,589129745891305 )
J Am Med Inform Assoc - Prescribers' expectations and barriers to electronic prescribing of controlled substances. ( 0,574450357494071 )
AMIA Annu Symp Proc - Improving Medication Adherence in a Regional Healthcare Information Exchange using a Scalable, Claims-Driven, and Service-Oriented Approach. ( 0,573240406149725 )
Med Biol Eng Comput - Strategy for NSAID administration to aspirin-intolerant asthmatics in combination with PGE2 analogue: a theoretical approach. ( 0,566664547100366 )
Int J Med Inform - An asthma management system in a pediatric emergency department. ( 0,561719450673467 )
J Am Med Inform Assoc - Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period. ( 0,558951909199816 )
J Am Med Inform Assoc - Early cost and safety benefits of an inpatient electronic health record. ( 0,551713627044966 )
Comput Methods Programs Biomed - Supporting adaptive clinical treatment processes through recommendations. ( 0,551090051010449 )
Int J Med Inform - Implementation of computerized provider order entry in a neonatal intensive care unit: Impact on admission workflow. ( 0,549421477073867 )
AMIA Annu Symp Proc - An Algorithm Using Twelve Properties of Antibiotics to Find the Recommended Antibiotics, as in CPGs. ( 0,549397138075862 )
AMIA Annu Symp Proc - Reducing wrong patient selection errors: exploring the design space of user interface techniques. ( 0,548076127449015 )
Int J Med Inform - From clinical practice guidelines, to clinical guidance in practice - impacts for computerization. ( 0,542935483071449 )
J Telemed Telecare - A pilot project for improving paediatric diabetes outcomes using a website: the Pediatric Diabetes Education Portal. ( 0,542320111293095 )
J Am Med Inform Assoc - Actionable reminders did not improve performance over passive reminders for overdue tests in the primary care setting. ( 0,540583703270805 )
AMIA Annu Symp Proc - Exceptions handling within GLARE clinical guideline framework. ( 0,539929787140827 )
BMC Med Inform Decis Mak - Hospital implementation of health information technology and quality of care: are they related? ( 0,538923604705072 )
J Am Med Inform Assoc - Building better guidelines with BRIDGE-Wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability. ( 0,537133266642408 )
Comput. Aided Surg. - Clinical outcome after hypofractionated stereotactic radiotherapy (HSRT) for benign skull base tumors. ( 0,536357472576565 )
J Clin Monit Comput - Ventilator-associated pneumonia: current status and future recommendations. ( 0,534419861776283 )
Int J Med Inform - Impact of electronic order management on the timeliness of antibiotic administration in critical care patients. ( 0,533824917197634 )
J Am Med Inform Assoc - High-priority drug-drug interactions for use in electronic health records. ( 0,533289232272476 )
AMIA Annu Symp Proc - Representation of Clinical Nursing Protocols Using GEM II & GEM Cutter. ( 0,533179526400828 )
J Telemed Telecare - Telemedicine-supported insulin optimisation in primary care. ( 0,529630303549845 )
BMC Med Inform Decis Mak - Variability of the impact of adverse events on physicians' decision making. ( 0,529332339041238 )
J Biomed Inform - Mitigation of adverse interactions in pairs of clinical practice guidelines using constraint logic programming. ( 0,525475810739791 )
BMC Med Inform Decis Mak - Practice guidelines and clinical risk assessment models: is it time to reform? ( 0,52402417522857 )
Int J Med Inform - SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored. ( 0,523627453809804 )
Comput Methods Programs Biomed - A guideline-based decision support for pharmacological treatment can improve the quality of hyperlipidemia management. ( 0,523623909615103 )
AMIA Annu Symp Proc - Evaluating the effectiveness of clinical alerts: a signal detection approach. ( 0,521888038724123 )
J Am Med Inform Assoc - Collaborative knowledge acquisition for the design of context-aware alert systems. ( 0,521661430170209 )
Methods Inf Med - A decision support system for the treatment of patients with ventricular assist device support. ( 0,518813811014192 )
J Am Med Inform Assoc - Temporal and other factors that influence the time doctors take to prescribe using an electronic prescribing system. ( 0,518370301342482 )
Int J Med Inform - Implementation of an automated system for monitoring adherence to hemodialysis treatment: a report of seven years of experience. ( 0,517094089555542 )
Methods Inf Med - From clinical practice guidelines to computer-interpretable guidelines. A literature overview. ( 0,516937606329452 )
J Telemed Telecare - Evaluation of a telemedical care programme for patients with Parkinson's disease. ( 0,516894341787958 )
J Med Syst - Using recommendation to support adaptive clinical pathways. ( 0,514596445304807 )
J. Med. Internet Res. - Diabetes patients' experiences with the implementation of insulin therapy and their perceptions of computer-assisted self-management systems for insulin therapy. ( 0,513644042825355 )
Health Informatics J - Effects of a computerized decision support system in improving pharmacological management in high-risk cardiovascular patients: A cluster-randomized open-label controlled trial. ( 0,513368757900358 )
Int J Med Inform - Functionality test for drug safety alerting in computerized physician order entry systems. ( 0,513030752112776 )
Methods Inf Med - Chronological bias in randomized clinical trials arising from different types of unobserved time trends. ( 0,512325741464861 )
AMIA Annu Symp Proc - Making audit actionable: an example algorithm for blood pressure management in chronic kidney disease. ( 0,510918065818874 )
J. Med. Internet Res. - An analysis of online evaluations on a physician rating website: evidence from a German public reporting instrument. ( 0,510011582185058 )
J Am Med Inform Assoc - Adherence to drug-drug interaction alerts in high-risk patients: a trial of context-enhanced alerting. ( 0,506793668953021 )
J Telemed Telecare - Telemonitoring in chronic obstructive airway disease and adult patients with cystic fibrosis. ( 0,506319545447395 )
Int J Med Inform - Complexity and the science of implementation in health IT--knowledge gaps and future visions. ( 0,506028226576445 )
Appl Clin Inform - An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. ( 0,505560930036309 )
Healthc (Amst) - Structuring the patient-physician encounter: Joint creation of an actionable roadmap to health. ( 0,504529822619059 )
J Am Med Inform Assoc - The feasibility of automating audit and feedback for ART guideline adherence in Malawi. ( 0,504458068640216 )
Appl Clin Inform - Innovative telemonitoring system for cardiology: from science to routine operation. ( 0,502760503928173 )
J. Med. Internet Res. - An evaluation of web-based clinical practice guidelines for managing problems associated with cannabis use. ( 0,501899436163965 )
Telemed J E Health - Utilization of the American Telemedicine Association's clinical practice guidelines. ( 0,501614624040046 )
BMC Med Inform Decis Mak - Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence. ( 0,501243587031278 )
Appl Clin Inform - Towards meaningful medication-related clinical decision support: recommendations for an initial implementation. ( 0,500196229327434 )
Comput. Biol. Med. - Sensitivity analysis of state-transition models: how to deal with a large number of inputs. ( 0,498944317309468 )
J Am Med Inform Assoc - Relationship between medication event rates and the Leapfrog computerized physician order entry evaluation tool. ( 0,498235151900843 )
J Am Med Inform Assoc - Performance factors of mobile rich media job aids for community health workers. ( 0,496954266061323 )
Res Synth Methods - A tool to assess the quality of a meta-analysis. ( 0,496696061014706 )
J. Med. Internet Res. - Pain-QuILT: clinical feasibility of a web-based visual pain assessment tool in adults with chronic pain. ( 0,494664387622975 )
J Clin Monit Comput - Cardiac asynchrony in Duchenne muscular dystrophy. ( 0,490723674318664 )
Neural Comput - Coenzyme Q10 benefits symptoms in Gulf War veterans: results of a randomized double-blind study. ( 0,489407429561781 )
J Am Med Inform Assoc - Overrides of medication-related clinical decision support alerts in outpatients. ( 0,48853250899211 )
BMC Med Inform Decis Mak - A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties. ( 0,488333208779665 )
J. Med. Internet Res. - Directed use of the internet for health information by patients with chronic kidney disease: prospective cohort study. ( 0,487247099524683 )
Appl Clin Inform - Developing clinical decision support within a commercial electronic health record system to improve antimicrobial prescribing in the neonatal ICU. ( 0,487188389508298 )
BMC Med Inform Decis Mak - Is increasing complexity of algorithms the price for higher accuracy? virtual comparison of three algorithms for tertiary level management of chronic cough in people living with HIV in a low-income country. ( 0,485724762653712 )
J Telemed Telecare - Relation between telecare implementation and number of treatment days in a Japanese town. ( 0,485339579914657 )
Telemed J E Health - Nonmydriatic retinal image review at time of endocrinology visit results in short-term HbA1c reduction in poorly controlled patients with diabetic retinopathy. ( 0,485186270822418 )
Appl Clin Inform - Electronic medical record prompts for lab orders in patients initiating statins. ( 0,485122495535731 )
Artif Intell Med - Evaluation of rule effectiveness and positive predictive value of clinical rules in a Dutch clinical decision support system in daily hospital pharmacy practice. ( 0,48409558239309 )
Int J Med Inform - What, if all alerts were specific - estimating the potential impact on drug interaction alert burden. ( 0,483956761050806 )
Int J Med Inform - Impact of a clinical decision support system for high-alert medications on the prevention of prescription errors. ( 0,483938285976297 )
Comput Math Methods Med - Analysis of a single hemodialysis on phosphate removal of the internal fistula patients by mathematical and statistical methods. ( 0,483791594302987 )
Med Biol Eng Comput - Non-invasive diagnosis of risk in dengue patients using bioelectrical impedance analysis and artificial neural network. ( 0,482960667923979 )
AMIA Annu Symp Proc - Effectiveness of Evidence-Based Congestive Heart Failure (CHF) CPOE Order Sets Measured by Health Outcomes. ( 0,482097149380812 )
J Biomed Inform - Efficient management of multi-version clinical guidelines. ( 0,48206022625351 )
Appl Clin Inform - Analysis of electronic medication orders with large overdoses: opportunities for mitigating dosing errors. ( 0,481946413352477 )
Comput Methods Programs Biomed - A smart medication recommendation model for the electronic prescription. ( 0,48101693935308 )
Perspect Health Inf Manag - Does an education intervention improve physician signature legibility? Pilot study of a prospective chart review. ( 0,480906398862283 )
J Telemed Telecare - Use of telemedicine in subjects with type 1 diabetes equipped with an insulin pump and real-time continuous glucose monitoring. ( 0,480702127364569 )
J Telemed Telecare - A meta-analysis of the use of electronic reminders for patient adherence to medication in chronic disease care. ( 0,480163215863516 )
Int J Med Inform - Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. ( 0,479341698668927 )
BMC Med Inform Decis Mak - Detecting and diagnosing hotspots for the enhanced management of hospital Emergency Departments in Queensland, Australia. ( 0,477665487849003 )
IEEE Trans Image Process - A protocol for evaluating video trackers under real-world conditions. ( 0,477013343110042 )
Int J Med Inform - Comparing the working time between Bar-Code Medication Administration system and traditional medication administration system: an observational study. ( 0,476181359890953 )
J Biomed Inform - The impact of emerging standards adoption on automated quality reporting. ( 0,4759594966766 )
Appl Clin Inform - Monitoring adherence to evidence-based practices: a method to utilize HL7 messages from hospital information systems. ( 0,474531234677665 )
Int J Med Inform - Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients. ( 0,47277680690137 )
J Am Med Inform Assoc - A long-term follow-up evaluation of electronic health record prescribing safety. ( 0,47213911274244 )
AMIA Annu Symp Proc - Developing nursing computer interpretable guidelines: a feasibility study of heart failure guidelines in homecare. ( 0,472053304815205 )
Health Info Libr J - Evaluating clinical librarian services: a systematic review. ( 0,471251841835035 )
J Am Med Inform Assoc - Evaluation of computer-generated reminders to improve CD4 laboratory monitoring in sub-Saharan Africa: a prospective comparative study. ( 0,470958035329629 )
J Am Med Inform Assoc - Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM. ( 0,470661460079778 )