scholarly journals Development of a Tailored Intervention With Computerized Clinical Decision Support to Improve Quality of Care for Patients With Knee Osteoarthritis: Multi-Method Study (Preprint)

2018 ◽  
Author(s):  
Stijn Van de Velde ◽  
Tiina Kortteisto ◽  
David Spitaels ◽  
Gro Jamtvedt ◽  
Pavel Roshanov ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Decision Support ◽  
Focus Group ◽  
Knee Osteoarthritis ◽  
General Practitioners ◽  
Guideline Implementation ◽  
Patient Specific ◽  
Evidence Based ◽  
Study Results

BACKGROUND Clinical practice patterns greatly diverge from evidence-based recommendations to manage knee osteoarthritis conservatively before resorting to surgery. OBJECTIVE This study aimed to tailor a guideline-based computerized decision support (CDS) intervention that facilitates the conservative management of knee osteoarthritis. METHODS Experts with backgrounds in clinical medicine, research, implementation, or health informatics suggested the most important recommendations for implementation, how to develop an implementation strategy, and how to form the CDS algorithms. In 6 focus group sessions, 8 general practitioners and 22 patients from Norway, Belgium, and Finland discussed the suggested CDS intervention and identified factors that would be most critical for the success of the intervention. The focus group moderators used the GUideline Implementation with DEcision Support checklist, which we developed to support consideration of CDS success factors. RESULTS The experts prioritized 9 out of 22 recommendations for implementation. We formed the concept for 6 CDS algorithms to support implementation of these recommendations. The focus group suggested 59 unique factors that could affect the success of the presented CDS intervention. Five factors (out of the 59) were prioritized by focus group participants in every country, including the perceived potential to address the information needs of both patients and general practitioners; the credibility of CDS information; the timing of CDS for patients; and the need for personal dialogue about CDS between the general practitioner and the patient. CONCLUSIONS The focus group participants supported the CDS intervention as a tool to improve the quality of care for patients with knee osteoarthritis through shared, evidence-based decision making. We aim to develop and implement the CDS based on these study results. Future research should address optimal ways to (1) provide patient-directed CDS, (2) enable more patient-specific CDS within the context of patient complexity, and (3) maintain user engagement with CDS over time.

scholarly journals Efficacy of a training programme to support the application of the guideline evidence-based health information: study protocol of a randomised controlled trial

2020 ◽  
Author(s):  
Julia Lühnen ◽  
Birte Berger-Höger ◽  
Burkhard Haastert ◽  
Jana Hinneburg ◽  
Jürgen Kasper ◽  
...  
Keyword(s):  
Health Information ◽  
Evidence Based Medicine ◽  
Information Quality ◽  
Guideline Implementation ◽  
Training Programme ◽  
Control Group ◽  
Evidence Based ◽  
Study Results ◽  
Based Medicine

Abstract Background The evidence-based guideline entitled guideline evidence-based health information emerged from the German Network for Evidence-based Medicine (DNEbM) and was published in February 2017. The guideline addresses providers of health information and its goal is to improve the quality of health information. In addition, we explored the competences of providers of health information and developed a training programme. Aim of this study is to evaluate the efficacy of a training programme addressing providers of health information to support the application of the guideline evidence-based health information. We expected the intervention to improve the quality of health information in comparison to the provision of the guideline on its own. Methods The trial uses a superiority randomised control group design with ten months follow-up. 26 providers of health information (groups with up to ten members) will be enrolled to compare the intervention (guideline & training programme) with usual care ( a publicly available guideline). The 5-day training programme comprises an evidence-based medicine training module and a module to prepare the application of the guideline. The primary outcome parameter is the quality of the health information. Quality is operationalised as the extent of adherence to the guideline’s recommendations. Each provider will prepare a single health information informing a health-related decision on a topic freely chosen before randomisation. The quality of this information will be rated using the Mapping Health Information Quality (MAPPinfo) checklist. An accompanying process evaluation will then be conducted. Discussion The study results will show whether the efficacy of the intervention justifies implementation of the training programme to enhance health information developers’ competences in evidence-based medicine and to ensure high-quality EBHI in the long-term. Trial registration ISRCTN registry, registration number: ISRCTN96941060, Date: 7 March 2019, URL: http://www.isrctn.com/ISRCTN96941060 Keywords health information; guideline implementation, training programme; evidence-based medicine; guideline evidence-based health information

scholarly journals A Narrative Review of Clinical Decision Support for Inpatient Clinical Pharmacists

2021 ◽  
Vol 12 (02) ◽  
pp. 199-207
Author(s):  
Liang Yan ◽  
Thomas Reese ◽  
Scott D. Nelson
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Controlled Trials ◽  
Clinical Pharmacists ◽  
Randomized Controlled ◽  
The Impact

Abstract Objective Increasingly, pharmacists provide team-based care that impacts patient care; however, the extent of recent clinical decision support (CDS), targeted to support the evolving roles of pharmacists, is unknown. Our objective was to evaluate the literature to understand the impact of clinical pharmacists using CDS. Methods We searched MEDLINE, EMBASE, and Cochrane Central for randomized controlled trials, nonrandomized trials, and quasi-experimental studies which evaluated CDS tools that were developed for inpatient pharmacists as a target user. The primary outcome of our analysis was the impact of CDS on patient safety, quality use of medication, and quality of care. Outcomes were scored as positive, negative, or neutral. The secondary outcome was the proportion of CDS developed for tasks other than medication order verification. Study quality was assessed using the Newcastle–Ottawa Scale. Results Of 4,365 potentially relevant articles, 15 were included. Five studies were randomized controlled trials. All included studies were rated as good quality. Of the studies evaluating inpatient pharmacists using a CDS tool, four showed significantly improved quality use of medications, four showed significantly improved patient safety, and three showed significantly improved quality of care. Six studies (40%) supported expanded roles of clinical pharmacists. Conclusion These results suggest that CDS can support clinical inpatient pharmacists in preventing medication errors and optimizing pharmacotherapy. Moreover, an increasing number of CDS tools have been developed for pharmacists' roles outside of order verification, whereby further supporting and establishing pharmacists as leaders in safe and effective pharmacotherapy.

Developing an Evidence-Based Clinical Decision-Support System to Enhance Prosthetic Prescription

2021 ◽  
Vol 10 (1) ◽  
pp. 121-125
Author(s):  
Pratima Saravanan ◽  
Jessica Menold
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Decision Support System ◽  
Gait Analysis ◽  
Support System ◽  
Patient Specific ◽  
Evidence Based ◽  
Extensive Literature ◽  
Analysis Tool ◽  
Care Providers

With the rapid increase in the global amputee population, there is a clear need to assist amputee care providers with their decision-making during the prosthetic prescription process. To achieve this, an evidence-based decision support system that encompasses existing literature, current decision-making strategies employed by amputee care providers and patient-specific factors is proposed. Based on an extensive literature review combined with natural language processing and expert survey, the factors influencing the current decision-making of amputee care providers in prosthetic prescription were identified. Following that, the decision-making strategies employed by expert and novice prosthetists were captured and analyzed. Finally, a fundamental understanding of the effect gait analysis has on the decision-making strategies of prosthetists was studied. Findings from this work lay the foundation for developing a real-time decision support system integrated with a portable gait analysis tool to enhance prescription processes. This is critical in the low-income countries where there is a scarcity of amputee care providers and resources for an appropriate prescription.

Abstract P263: Computer-Assisted Decision Support in the Treatment of Acute Coronary Syndromes and Impact on Cardiovascular Outcomes

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Richard V Milani ◽  
Carl J Lavie ◽  
Daniel P Morin ◽  
Andres Rubiano
Keyword(s):  
Quality Of Care ◽  
Decision Support ◽  
Baseline Risk ◽  
Risk Scores ◽  
Computer Assisted ◽  
Improve Quality ◽  
Consensus Guidelines ◽  
Mortality And Morbidity ◽  
Coronary Syndrome

Background: Evidence from clinical trials and consensus guidelines suggest that in-hospital initiation of key therapeutics can reduce mortality and morbidity in patients admitted with acute coronary syndrome (ACS). As a result, the AHA and ACC have co-developed guideline-based “performance measures” for ACS patients, such that when every measure has been performed, the patient is considered to have achieved optimal or “perfect” care (PC). Computer-assisted decision support (CADS) is a tool that can improve quality of care and is well suited for complex algorithms governing treatment decisions. We sought to determine if CADS tailored to ACS would enhance the likelihood of achieving PC, and whether achievement of PC would translate into reduced mortality. Methods: 452 consecutive patients (mean age 68±13 years) admitted with ACS in 2009 were evaluated (unstable angina 29%, NSTEMI 61%, STEMI 10%). Physicians had the option of using either pre-printed ACS orders (standard orders) versus CADS generated orders. The CADS system utilized patient clinical data including risk scoring, to suggest specific therapeutics and drug dosing based on consensus guidelines. Endpoints were attainment of PC and 30-day mortality. Results: The 77 patients admitted using CADS generated orders were statistically similar (age, gender, ACS diagnosis, TIMI risk) to the 375 patients admitted with the standard order set. Attainment of PC was almost twice as likely when using CADS versus standard orders (84% vs. 44%, p<0.05). PC patients trended towards higher TIMI risk scores (3.2 ±1.7 vs 2.9 ±1.6, p = 0.09) but had half the 30-day mortality (2% vs 4%, p=0.05) compared to patients not achieving PC. Conclusions: Use of CADS in the setting of ACS is feasible and doubles the likelihood of attaining PC. Although patients achieving PC had higher baseline risk, their mortality was reduced by 50% compared to those not achieving PC. These data support the use of CADS in the setting of ACS to improve quality of care and subsequent outcomes.

scholarly journals PENERAPAN PRAKTIK KEPERAWATAN BERBASIS BUKTI PURSED LIP BREATHING PADA PASIEN DENGAN PENYAKIT PARU OBSTRUKTIF KRONIK DI RUANG RSU PUSAT PERSAHABATAN JAKARTA

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Seven Sitorus
Keyword(s):  
Quality Of Care ◽  
Pulmonary Disease ◽  
Significant Influence ◽  
Exercise Tolerance ◽  
P Value ◽  
Evidence Based ◽  
Copd Exacerbation ◽  
Before And After ◽  
Evidence Based Nursing

Background: Chronic Obstruction Pulmonary Disease (COPD) is disease characterized by obstruction air flow in the breath not wholly reversible. One treatment can be done on improving exercise tolerance is exercise respiration as pursed lip breathing ( PLB ). Purse lip breathing is a techniques of breathing carried out to expelling air by creating power through  in move closer /pursed lips. Purpose: provide an illustration of the application of the practice of evidence based nursing of pursed lip breathing in patients COPD in RSUP Persahabatan Jakarta. Method:  the implementation of the practice of evidence based nursing pursed lip breathing is applied to 12 people sample ( 10 men and 2 women ) diagnosed with COPD exacerbation. Result: the majority of sex respondents is man as many as 10 ( 83,3 % ) persons and women as many as 2 ( 16,7 % ) a person .mean the age of respondents is 61,5 years ± 10.4 .mean the value of PEF ( Peak Expiratory Flow ), the value of the saturation oxygen , the value of respiratori rate before the intervention in a consecutive manner is 131.6 ±  44.6; 92.1 ± 2.44; 31.5 ±  2 . While value after the intervention is 175.0 ±  60.0; 97,1 ± 1.6; 22,6 ± 1.7 with P value = 0.001, α = 0.05. Conclusions: there are significant influence the application of pursed lip breathing between before and after the intervention in patients COPD. Advice: Intervention evidence based nursing can be applied to all patients COPD so reached the quality of care of nursing based on research

Med-on-@ix

2011 ◽  
pp. 974-994
Author(s):  
In-Sik Na ◽  
Max Skorning ◽  
Arnd T. May ◽  
Marie-Thérèse Schneiders ◽  
Michael Protogerakis ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Evidence Based Medicine ◽  
Vital Signs ◽  
Personal Data ◽  
Clinical Findings ◽  
Evidence Based ◽  
Physician Shortage ◽  
Virtual Presence ◽  
Based Medicine

The aim of the project Med-on-@ix is to increase the quality of care for emergency patients by the operationalisation of rescue processes. The currently available technologies will be integrated into a new emergency telemedical service system. The aim is to capture all the necessary information comprising electrocardiogram, vital signs, clinical findings, images and necessary personal data of a patient at the emergency scene and transmit this data in real time to a centre of competence. This would enable a “virtual presence” on site of an Emergency Medical Services physician (EMS-physician, the German Notarzt). Thus, we can raise the quality of EMS in total and counter the growing problem of EMS-physician shortage by exploiting the existing medical resources. In addition, this system offers EMS-physicians and paramedics consultation from a centre of competence. Thereby referring to evidence-based medicine and ensuring the earliest possible information of the hospital.

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