Cooperative Efforts Improve Compliance with Acute Stroke Guidelines

Albakri, Erfan A.; Richards, Ferdinand; Hall, Marie Boas; Dion, Charles; Miranda, Luis Salvador; Turkel, Robert; Sand, Charles; Vasey, Paulette; McDonald, Kathie; Michelman, Mark; Smith, Zaid; Davison, Karen; Pfannerstill, Lisa

doi:10.1097/01.smj.0000047627.78898.ab

Cited by 10 publications

(4 citation statements)

References 8 publications

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“…They can involve the derivation of quality indicators and the aggregation of expert opinions as well as various clinical data to obtain compliance scores [37,38]. We did not incorporate such checks into this study, but think that integration of various such metrics would be possible with the same set-up, yielding valuable insights for decision makers in healthcare that may not be possible with merely manual efforts.…”

Section: Discussionmentioning

confidence: 99%

Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR’s Guideline Definition Language

Anani

Chen

Moreira

et al. 2014

BMC Med Inform Decis Mak

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BackgroundProviding scalable clinical decision support (CDS) across institutions that use different electronic health record (EHR) systems has been a challenge for medical informatics researchers. The lack of commonly shared EHR models and terminology bindings has been recognised as a major barrier to sharing CDS content among different organisations. The openEHR Guideline Definition Language (GDL) expresses CDS content based on openEHR archetypes and can support any clinical terminologies or natural languages. Our aim was to explore in an experimental setting the practicability of GDL and its underlying archetype formalism. A further aim was to report on the artefacts produced by this new technological approach in this particular experiment. We modelled and automatically executed compliance checking rules from clinical practice guidelines for acute stroke care.MethodsWe extracted rules from the European clinical practice guidelines as well as from treatment contraindications for acute stroke care and represented them using GDL. Then we executed the rules retrospectively on 49 mock patient cases to check the cases’ compliance with the guidelines, and manually validated the execution results. We used openEHR archetypes, GDL rules, the openEHR reference information model, reference terminologies and the Data Archetype Definition Language. We utilised the open-sourced GDL Editor for authoring GDL rules, the international archetype repository for reusing archetypes, the open-sourced Ocean Archetype Editor for authoring or modifying archetypes and the CDS Workbench for executing GDL rules on patient data.ResultsWe successfully represented clinical rules about 14 out of 19 contraindications for thrombolysis and other aspects of acute stroke care with 80 GDL rules. These rules are based on 14 reused international archetypes (one of which was modified), 2 newly created archetypes and 51 terminology bindings (to three terminologies). Our manual compliance checks for 49 mock patients were a complete match versus the automated compliance results.ConclusionsShareable guideline knowledge for use in automated retrospective checking of guideline compliance may be achievable using GDL. Whether the same GDL rules can be used for at-the-point-of-care CDS remains unknown.

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Section: Discussionmentioning

confidence: 99%

Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR’s Guideline Definition Language

Anani

Chen

Moreira

et al. 2014

BMC Med Inform Decis Mak

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“…A UK study showed that a more flexible effort led by individual physicians to apply evidence‐based guidelines was more effective than organizationally enforced efforts [50]. This would explain the effectiveness of addressing the barriers to physicians using guidelines, through presentations by opinion leaders and by educational outreach [51–54].…”

Section: Discussionmentioning

confidence: 99%

Clinical practice guidelines for the initial management of urinary incontinence in women: a European‐focused review

Viktrup¹,

Summers²,

Dennett³

2004

BJU International

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“…To accept that decisions should primarily be based on scientific evidence is to accept that they should not be based on other aspects. However, national and international surveys suggest that compliance with clinical practice guidelines is still only moderate (Hasenbein et al 2006;Albakri et al 2003;Mohammed et al 2005) and that there seems to be no positive correlation between physicians' adherence to guidelines and the underlying strength of evidence (Hasenbein et al 2006;Brand et al 2005). In health care, disagreements frequently occur over thresholds for interventions or whether potential harm exceeds potential benefits.…”

mentioning

confidence: 96%

Patient-based medicine: aligning patients’ perspectives on disease and treatment with evidence-based medicine criteria

Rohrbacher¹,

Marx

Schaufler

et al. 2008

J Public Health

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Cooperative Efforts Improve Compliance with Acute Stroke Guidelines

Abstract: Feedback on performance, coupled with proactive collaboration with emergency department staff, resulted in improved compliance with the stroke guidelines.

Cited by 10 publications

References 8 publications

Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR’s Guideline Definition Language

Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR’s Guideline Definition Language

Clinical practice guidelines for the initial management of urinary incontinence in women: a European‐focused review

Patient-based medicine: aligning patients’ perspectives on disease and treatment with evidence-based medicine criteria

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