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.

Tópicos

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Resumo

CKGROUND: Stage 2 Meaningful Use criteria require the use of clinical decision support systems (CDSS) on high priority health conditions to improve clinical quality measures. Although CDSS hold great promise, implementation has been fraught with challenges, evidence of their impact is mixed, and the optimal method of content delivery is unknown.OBJECTIVE: The authors investigated whether implementation of a simple clinical decision support (CDS) tool was associated with improved prescriber adherence to national medication-laboratory monitoring guidelines for safety (hepatic function, renal function, myalgias/rhabdomyolysis) and intermediate outcomes for antidiabetic (Hemoglobin A(1c); HbA(1c)) and antihyperlipidemic (low density lipoprotein; LDL) medications prescribed within a diabetes registry.METHODS: This was a retrospective observational study conducted in three phases of CDS implementation (2008-2009): pre-, transition-, and post-Prescriptions evaluated were ordered from an electronic health record within a multispecialty medical group. Adherence was evaluated within and without applying guideline-imposed time constraints.RESULTS: Forty-thousand prescriptions were ordered over three timeframes. For hepatic and renal function, the proportion of prescriptions for which labs were monitored at any time increased from 52% to 65% (p<0.001); those that met time guidelines, from 14% to 21% (p<0.001). Only 6% of required labs were drawn to monitor for myalgias/rhabdomyolysis, regardless of timeframe. Over 90% of safety labs were within normal limits. The proportion of labs monitored at any time for LDL increased from 56% to 64% (p<0.001); those that met time guidelines from 11% to 17% (p<0.001). The proportion of labs monitored at any time for HbA(1c) remained the same (72%); those that met time guidelines decreased from 45% to 41% (p<0.001).CONCLUSION: A simple CDS tool may be associated with improved adherence to guidelines. Efforts are needed to confirm findings and improve the timeliness of monitoring; investigations to optimize alerts should be ongoing.

Resumo Limpo

ckground stage meaning use criteria requir use clinic decis support system cdss high prioriti health condit improv clinic qualiti measur although cdss hold great promis implement fraught challeng evid impact mix optim method content deliveri unknownobject author investig whether implement simpl clinic decis support cds tool associ improv prescrib adher nation medicationlaboratori monitor guidelin safeti hepat function renal function myalgiasrhabdomyolysi intermedi outcom antidiabet hemoglobin ac hbac antihyperlipidem low densiti lipoprotein ldl medic prescrib within diabet registrymethod retrospect observ studi conduct three phase cds implement pre transit postprescript evalu order electron health record within multispecialti medic group adher evalu within without appli guidelineimpos time constraintsresult fortythousand prescript order three timefram hepat renal function proport prescript lab monitor time increas p met time guidelin p requir lab drawn monitor myalgiasrhabdomyolysi regardless timefram safeti lab within normal limit proport lab monitor time ldl increas p met time guidelin p proport lab monitor time hbac remain met time guidelin decreas pconclus simpl cds tool may associ improv adher guidelin effort need confirm find improv timeli monitor investig optim alert ongo

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