Computed Critiquing Integrated into Daily Clinical Practice Affects Physicians’ Behavior

Kuilboer, M. M.; Mosseveld, M.; Does, E. van der; Jongste, Johan C. de; Overbeek, S. E.; Ponsioen, B.; Lei, J. van der; Wijk, Marc A. M. van

doi:10.1055/s-0038-1634103

Cited by 40 publications

(88 citation statements)

References 12 publications

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“…Twenty-one studies concerned the implementation of guidelines for disease management, of which 71% provided support for chronic diseases [12-17,22-26,30,32,34,35], 24% for acute diseases [10,18-21] and one for both [37]. Because brief prompts were excluded, only one system was included that addressed screening and/or prevention [11].…”

Section: Resultsmentioning

confidence: 99%

“…Targeted diseases were angina [24], coronary artery disease (CAD) [14], heart failure and ischemic heart disease [15], hypertension [17,22,26,34], dyslipidemia [32], hypercholesterolemia [33], diabetes [12,14,35], asthma/chronic obstructive pulmonary disease (COPD) [16,24,25,30,33], depression [13], HIV [23], occupational exposure to body fluids [19], acute low back pain [18], otitis media [21], and fever in children [20]. The study by Davis was related to various common pediatric diseases [10] and the study by Jousimaa [37] to various primary care problems.…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of electronic guideline-based implementation systems in ambulatory care settings - a systematic review

et al. 2009

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BackgroundElectronic guideline-based decision support systems have been suggested to successfully deliver the knowledge embedded in clinical practice guidelines. A number of studies have already shown positive findings for decision support systems such as drug-dosing systems and computer-generated reminder systems for preventive care services.MethodsA systematic literature search (1990 to December 2008) of the English literature indexed in the Medline database, Embase, the Cochrane Central Register of Controlled Trials, and CRD (DARE, HTA and NHS EED databases) was conducted to identify evaluation studies of electronic multi-step guideline implementation systems in ambulatory care settings. Important inclusion criterions were the multidimensionality of the guideline (the guideline needed to consist of several aspects or steps) and real-time interaction with the system during consultation. Clinical decision support systems such as one-time reminders for preventive care for which positive findings were shown in earlier reviews were excluded. Two comparisons were considered: electronic multidimensional guidelines versus usual care (comparison one) and electronic multidimensional guidelines versus other guideline implementation methods (comparison two).ResultsTwenty-seven publications were selected for analysis in this systematic review. Most designs were cluster randomized controlled trials investigating process outcomes more than patient outcomes. With success defined as at least 50% of the outcome variables being significant, none of the studies were successful in improving patient outcomes. Only seven of seventeen studies that investigated process outcomes showed improvements in process of care variables compared with the usual care group (comparison one). No incremental effect of the electronic implementation over the distribution of paper versions of the guideline was found, neither for the patient outcomes nor for the process outcomes (comparison two).ConclusionsThere is little evidence at the moment for the effectiveness of an increasingly used and commercialised instrument such as electronic multidimensional guidelines. After more than a decade of development of numerous electronic systems, research on the most effective implementation strategy for this kind of guideline-based decision support systems is still lacking. This conclusion implies a considerable risk towards inappropriate investments in ineffective implementation interventions and in suboptimal care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Effectiveness of electronic guideline-based implementation systems in ambulatory care settings - a systematic review

et al. 2009

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“…In a limited way, EMRs are being used as a means of enabling best practices, by incorporating prompts, alerts and/or decision support. Incorporating decision support into EMRs led to a change in how physicians monitored their patients with asthma and chronic obstructive pulmonary disease (COPD) in the Netherlands [6] and an increase in pediatricians' adherence to asthma guideline recommendations in Connecticut, USA [7]. Prompting physicians to document smoking status resulted in modest improvement in guideline adherence [8].…”

Section: Introductionmentioning

confidence: 98%

Development and implementation of an electronic asthma record for primary care: integrating guidelines into practice

et al. 2013

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“…AsthmaCritic is another decision-support system that operates within a computer system with electronic medical records [60, 61]. It reviews physicians' treatment in the light of current guidelines and the knowledge base and generates patient-specific feedback in the form of critical comments.…”

Section: Introductionmentioning

confidence: 99%

“…AsthmaCritic was developed to use routinely recorded data, to be integrated with daily practice, and to be part of a physician's working environment. This tool was shown to change the manner in which physicians monitored their patients as well as their treatment patterns and data-recording habits [60]. …”

Section: Introductionmentioning

confidence: 99%

Educational and decision-support tools for asthma-management guideline implementation

Kim

Cho

2012

Asia Pacific Allergy

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Many international and national asthma guidelines are now available in large parts of the world, but they are not yet implemented appropriately. There is a gap between scientific evidence-based medicine and real clinical practice. Implementation of guidelines is highly complex. Special strategies are needed to encourage guideline-based, high-quality care. It is important to understand the contents, the format, and the learning strategies which physicians prefer for the dissemination of guidelines. Physicians prefer more concise and immediately available guidelines that are practical to use. Thus, asthma guidelines should be disseminated as convenient and easily accessible tools. Various education programs and decision-support tools have been designed and applied to the clinical management of asthma to solve these challenging problems. Many of them have been shown to be effective at increasing physicians' knowledge and adherence to asthma guidelines and improving patients' clinical outcomes. These educational and decision-support tools are expected to contribute to a narrowing of the gap between asthma guidelines and practice/implementation of the guidelines.

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Computed Critiquing Integrated into Daily Clinical Practice Affects Physicians’ Behavior

Abstract: Our study shows that the guideline-based critiquing system AsthmaCritic changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits.

Cited by 40 publications

References 12 publications

Effectiveness of electronic guideline-based implementation systems in ambulatory care settings - a systematic review

Effectiveness of electronic guideline-based implementation systems in ambulatory care settings - a systematic review

Development and implementation of an electronic asthma record for primary care: integrating guidelines into practice

Educational and decision-support tools for asthma-management guideline implementation

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