Information systems in diabetes: in search of the holy grail in the era of evidence-based diabetes care

2001 ◽  
Vol 109 (Suppl 2) ◽  
pp. S358-S372 ◽  
Author(s):  
V. Montori ◽  
S. Smith
2011 ◽  
pp. 1994-2011
Author(s):  
Daniel Carbone

The aim of this chapter is to bridge the gap between what is known about IS theory and the specifics characteristics of health to develop an evidence based health information systems theory. An initial background first sets the significance for the need to have a solid information systems theory in health and then argues that neither the information systems literature nor the health sector have been able to provide any satisfactory pathway to facilitate the adoption of information systems in health settings. The chapter further continues by reviewing the common pathway to develop information systems theory and the knowledge foundations used in the process, and then proceeds to highlight how this theory was developed. Subsequently, the building blocks (constructs, premises, supporting evidence and conclusions) that underpins the constructs and a brief explanation of the relationships between them is included. A discussion and limitation section is then followed by a conclusion.


2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Shamala Ayadurai ◽  
H. Laetitia Hattingh ◽  
Lisa B. G. Tee ◽  
Siti Norlina Md Said

Background. We conducted a review of current diabetes intervention studies in type 2 diabetes and identified opportunities for pharmacists to deliver quality diabetes care.Methods. A search on randomised controlled trials (RCT) on diabetes management by healthcare professionals including pharmacists published between 2010 and 2015 was conducted.Results and Discussion. Diabetes management includes multifactorial intervention which includes seven factors as outlined in diabetes guidelines, namely, glycaemic, cholesterol and blood pressure control, medication, lifestyle, education, and cardiovascular risk factors. Most studies do not provide evidence that the intervention methods used included all seven factors with exception of three RCT which indicated HbA1c (glycated hemoglobin) reduction range of 0.5% to 1.8%. The varied HbA1C reduction suggests a lack of standardised and consistent approach to diabetes care. Furthermore, the duration of most studies was from one month to two years; therefore long term outcomes could not be established.Conclusion. Although pharmacists’ contribution towards improving clinical outcomes of diabetes patients was well documented, the methods used to deliver structured, consistent evidence-based care were not clearly stipulated. Therefore, approaches to achieving long term continuity of care are uncertain. An intervention strategy that encompass all seven evidence-based factors will be useful.


2013 ◽  
Vol 04 (01) ◽  
pp. 126-143 ◽  
Author(s):  
B. Tulu ◽  
M. Lawley ◽  
R. Konrad

SummaryBackground: Clinical pathways are evidence-based recommendations for treating a diagnosis. Although implementations of clinical pathways have reduced medical errors, lowered costs, and improved patient outcomes, monitoring whether a patient is following the intended pathway is problematic. Implementing a variance reporting program is impeded by the lack of a reliable source of electronic data and automatic retrieval methods.Objectives: Our objective is to develop an automated method of measuring and reporting patient variance from a clinical pathway.Methods: We identify a viable and ubiquitous data source for establishing the realized patient’s path- Health Level Seven (HL7) formatted message exchanges between Hospital Information Systems. This is in contrast to current practices in most hospitals where data for clinical pathway variance reporting is obtained from multiple data sources, often retrospectively. This paper develops a method to use message exchanges to automatically establish and compare a patient’s path against a clinical pathway. Our method not only considers pathway activities as is common practice, but also extracts patient outcomes from HL7 messages and reports this in addition to the variance.Results: Using data from our partner hospital, we illustrate our clinical pathway variance analysis tool using major joint replacement patients. We validate our method by comparing audit results for a random sample of HL7 constructed pathways with data extracted from patient charts. We report several variances such as omitted laboratory tests or additional activities such as blood transfusions. Our method successfully identifies variances and reports them in a quantified way to support decisions related to quality control.Conclusions: Our approach differs from previous studies in that a quantitative measure is established over three dimensions: (1) omissions from the pathway, (2) additions to the pathway, and (3) patient outcomes. By examining variances providers can evaluate clinical decisions, and support quality feedback and training mechanisms.Citation: Konrad R, Tulu B, Lawley M. Monitoring adherence to evidence based practices – a method to utilize HL7 messages from hospital information systems. Appl Clin Inf 2013; 4: 126–143http://dx.doi.org/10.4338/ACI-2012-06-RA-0026


QJM ◽  
2013 ◽  
Vol 106 (11) ◽  
pp. 983-987 ◽  
Author(s):  
T. A. Chowdhury ◽  
P. Bennett-Richards

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