Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes

Hunt, Dereck; Haynes, R. Brian; Hanna, Steven; Smith, Kristina

doi:10.1001/jama.280.15.1339

Cited by 1,364 publications

(854 citation statements)

References 70 publications

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“…Organizing the diagnosis, treatment, and followup care of these patients proved to be impossible from the outset in the absence of process management computer support. Such computer programs are widely used for process control and documentation in other industries, but are seldom used in health care (25,26). We have developed and tested a software program to meet these needs based on the fracture care algorithm (Figure 1) with the assistance of an experienced industrial process management consultant.…”

Section: Methodsmentioning

confidence: 99%

Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

Harrington¹,

Barash²,

Day³

et al. 2005

Arthritis & Rheumatism

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Objective. To develop new processes that assure more reliable, population-based care of fragility fracture patients. Methods. A 4-year clinical improvement project was performed in a multispecialty, community practice health system using evidence-based guidelines and rapid cycle process improvement methods (plan-do-study-act cycles). Results. Prior to this project, appropriate osteoporosis care was provided to only 5% of our 1999 hip fracture patients. In 2001, primary physicians were provided prompts about appropriate care (cycle 1), which resulted in improved care for only 20% of patients. A process improvement pilot in 2002 (cycle 2) and full program implementation in 2003 (cycle 3) have assured osteoporosis care for all willing and able patients with any fragility fracture. Altogether, 58% of 2003 fragility fracture patients, including 46% of those with hip fracture, have had a bone measurement, have been assigned to osteoporosis care with their primary physician or a consultant, and are being monitored regularly. Only 19% refused osteoporosis care. Key process improvements have included using orthopedic billings to identify patients, referring patients directly from orthopedics to an osteoporosis care program, organizing care with a nurse manager and process management computer software, assigning patients to primary or consultative physician care based on disease severity, and monitoring adherence to therapy by telephone. Conclusion. Reliable osteoporosis care is achievable by redesigning clinical processes. Performance data motivate physicians to reconsider traditional approaches. Improving the care of osteoporosis and other chronic diseases requires coordinated care across specialty boundaries and health system support.

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Section: Methodsmentioning

confidence: 99%

Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

Harrington¹,

Barash²,

Day³

et al. 2005

Arthritis & Rheumatism

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“…[21][22][23][24]40 Although not without limitation, 41,42 clinical decision support systems have been used to implement evidence-based practices across multiple conditions, [43][44][45][46][47][48][49] and many of these systems are being developed to be shareable across multiple healthcare systems, 50 especially in the U.S. in response to healthcare reform. Findings from the present and prior studies in VA suggest that while VA's alcohol screening clinical reminder has effectively prompted clinical staff to conduct screening and facilitated documentation that screening occurred, 9 it has not facilitated screening in a validated, standardized, reproducible way.…”

Section: Reports Of Adapting Screening To Enhance Patient Comfortmentioning

confidence: 99%

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

et al. 2015

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“…This is also important for avoiding futile transplantation with consequent inappropriate increase in demand on limited organ pool and cost of health care. When multiple and diverse factors are likely to influence decision making, computer-based decision support systems such as neural networks are often helpful in arriving at or supplementing a correct decision by the clinicians [4,5]. Pugh's modification of Child's scoring system is one of the most widely used scoring systems for prediction of mortality from cirrhosis [6].…”

Section: Introductionmentioning

confidence: 99%

Models for prediction of mortality from cirrhosis with special reference to artificial neural network: a critical review

Ghoshal

Das

2007

Hepatol Int

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Prediction of mortality of patients with cirrhosis of liver, a common and potentially fatal disease, is important for timely listing of patients for liver transplantation. The Child-Pugh scoring system has been widely used for predicting the outcome of liver cirrhosis. The Model for End-Stage Liver Disease (MELD) score has recently become popular for prediction of short-term mortality for organ allocation. A few studies that evaluated artificial neural network (ANN)-based model for prediction of outcome of cirrhosis of liver in terms of mortality have consistently shown it to be superior to Child-Pugh scoring and logistic regression-based models; it is worth noting that MELD score is also derived using the logistic regression model. Due to the inherent ability of neural network-based systems in identifying complex nonlinear interactions, ANN-based models are expected to perform better than most linear models, such as regression-based models. More studies are needed on ANN-based models for prediction of mortality of patients with cirrhosis of liver and its value in prioritization of organ allocation for treatment of patients with cirrhosis of liver.

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Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes

Abstract: Contact me if this article is corrected. CitationsContact me when this article is cited. This article has been cited 477 times. Topic collectionsContact me when new articles are published in these topic areas. Review the same issueRelated Articles published in

Cited by 1,364 publications

References 70 publications

Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

Models for prediction of mortality from cirrhosis with special reference to artificial neural network: a critical review

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