Standard practices for computerized clinical decision support in community hospitals: a national survey

Ash, Joan S.; McCormack, J; Sittig, Dean F.; Wright, Adam; McMullen, Carmit K.; Bates, David W.

doi:10.1136/amiajnl-2011-000705

Cited by 38 publications

(21 citation statements)

References 20 publications

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“…Such efforts, however, require a skilled workforce-a recent survey found that new job roles specific to computerised clinical decision support systems, such as knowledge engineers and analysts, as well as informatics or information services departments and dedicated governance structures, are being created in community hospitals to better customise decision support for the local needs. 41 Clinicians' participation and cooperation with these new processes is valuable in making systems safe and effective.…”

Section: Discussionmentioning

confidence: 99%

Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials

Roshanov

Fernandes

Wilczynski

et al. 2013

BMJ

364

335

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Objectives To identify factors that differentiate between effective and ineffective computerised clinical decision support systems in terms of improvements in the process of care or in patient outcomes.Design Meta-regression analysis of randomised controlled trials.Data sources A database of features and effects of these support systems derived from 162 randomised controlled trials identified in a recent systematic review. Trialists were contacted to confirm the accuracy of data and to help prioritise features for testing.Main outcome measures "Effective" systems were defined as those systems that improved primary (or 50% of secondary) reported outcomes of process of care or patient health. Simple and multiple logistic regression models were used to test characteristics for association with system effectiveness with several sensitivity analyses.Results Systems that presented advice in electronic charting or order entry system interfaces were less likely to be effective (odds ratio 0.37, 95% confidence interval 0.17 to 0.80). Systems more likely to succeed provided advice for patients in addition to practitioners (2.77, 1.07 to 7.17), required practitioners to supply a reason for over-riding advice (11.23, 1.98 to 63.72), or were evaluated by their developers (4.35, 1.66 to 11.44). These findings were robust across different statistical methods, in internal validation, and after adjustment for other potentially important factors. ConclusionsWe identified several factors that could partially explain why some systems succeed and others fail. Presenting decision support within electronic charting or order entry systems are associated with failure compared with other ways of delivering advice. Odds of success were greater for systems that required practitioners to provide reasons when over-riding advice than for systems that did not. Odds of success were also better for systems that provided advice concurrently to patients and practitioners. Finally, most systems were evaluated by their own developers and such evaluations were more likely to show benefit than those conducted by a third party.

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Section: Discussionmentioning

confidence: 99%

Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials

Roshanov

Fernandes

Wilczynski

et al. 2013

BMJ

364

335

View full text Add to dashboard Cite

show abstract

“…Clinical decision support systems are designed to improve provider decisions. When well designed and implemented, clinical decision support systems can improve patient safety, clinical workflow, guideline adherence, and quality of care . Evidence suggests that clinical decision support systems may also decrease malpractice events .…”

Section: Methodsmentioning

confidence: 99%

Knowledge Translation and Barriers to Imaging Optimization in the Emergency Department: A Research Agenda

Probst

Dayan

Raja

et al. 2015

Academic Emergency Medicine

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Researchers have attempted to optimize imaging utilization by describing which clinical variables are more predictive of acute disease and, conversely, what combination of variables can obviate the need for imaging. These results are then used to develop evidence-based clinical pathways, clinical decision instruments, and clinical practice guidelines. Despite the validation of these results in subsequent studies, with some demonstrating improved outcomes, their actual use is often limited. This article outlines a research agenda to promote the dissemination and implementation (also known as knowledge translation) of evidence-based interventions for emergency department (ED) imaging, i.e., clinical pathways, clinical decision instruments, and clinical practice guidelines. We convened a multidisciplinary group of stakeholders and held online and telephone discussions over a 6-month period culminating in an in-person meeting at the 2015 Academic Emergency Medicine consensus conference. We identified the following four overarching research questions: 1) what determinants (barriers and facilitators) influence emergency physicians' use of evidence-based interventions when ordering imaging in the ED; 2) what implementation strategies at the institutional level can improve the use of evidence-based interventions for ED imaging; 3) what interventions at the health care policy level can facilitate the adoption

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“…Details about the storage and measurements methods were in accordance with the Clinical Practices standards. [22] De nitions…”

Section: Data Collectionmentioning

confidence: 99%

Association Between Waist Circumference Change and Incident Chronic Obstructive Pulmonary Disease in Chinese Adults: An 18-year Cohort Study

Ma¹,

Zhao²,

Su³

2020

Preprint

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Background The aim of our study was to investigate waist circumference (WC) change and the risk of incident chronic obstructive pulmonary disease (COPD) among Chinese adults.Methods A total of 8,164 participants aged 20-35 years were recruited who attended health examination with the repeat measurements of WC and lung function (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1)) from 2001 to 2019. The data of same measurements were collected at their age of 38-53 years. Participants were categorized by WC change as ≤-2.5%, -2.5% to 2.5%, 2.5% to 5% and ＞5% according to gender. The modified Poisson regression models were used to assess the association of WC gain and the risk of COPD.Results During 18-year follow-up, a total of 917 COPD cases were identified. From baseline to follow-up, the mean of FEV1 decreased from 3.20 L to 2.79 L among male participants and 2.28 L to 1.95 L among female participants. Comparing with participants who were not abdominal obesity at both baseline and follow-up, participants with abdominal obesity among both genders after the follow-up were associated to the greater risk of COPD regardless of abdominal obesity at baseline. The risk of incident COPD increased 19% among male participants (RR=1.19, 95%CI=1.04-1.48) and 14% among female participants (RR=1.14, 95%CI=1.01-1.40) when WC gain increased ＞5% during the 18-year follow-up. The COPD risk decreased 28% among male participants with WC change ≤-2.5% (RR=0.82, 95%CI=0.67-0.99).Conclusions The risk of incident COPD was positively associated with increasing WC for both genders among Chinese adults.

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Standard practices for computerized clinical decision support in community hospitals: a national survey

Cited by 38 publications

References 20 publications

Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials

Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials

Knowledge Translation and Barriers to Imaging Optimization in the Emergency Department: A Research Agenda

Association Between Waist Circumference Change and Incident Chronic Obstructive Pulmonary Disease in Chinese Adults: An 18-year Cohort Study

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