Decision support systems in clinical practice: The case of venous thromboembolism prevention

Abstract

Coverage of hospitalized patients with documented VTE risk assessment gradually increased after the CDSS implementation, but remained at a low level (19% of eligible patients). Partly it may be attributed to the lack of CDSS integration in electronic health record or computerized physician order entry systems that would facilitate routine documentation of VTE and bleeding risks. However, the introduction of CDSS has allowed reducing significantly the rate of hospital-acquired VTE. This can be explained by drawing doctor's attention to the VTE problem and by training effect of CDSS. After receiving appropriate recommendations doctors adhere to them, on average, in 85.4% of cases, although for LMWH pharmacoprophylaxis this level was lower (74.6%). Development of hospital-acquired VTE in most cases (74%) was accompanied by non-compliance with CPGs recommendations, emphasizing the importance of additional measures for better adherence to evidence-based clinical practices.

A systematic model improves hepatitis C virus birth cohort screening in hospital‐based primary care

“…A study performed at a community hospital in New York reported a significant improvement in HCV screening rates from 47% to 88% with electronic interventions; however, this was done using an opt‐out approach for inpatient admissions, a significantly different methodology and population. What is clear, though, is that an overuse of such a system can result in “alert fatigue” and hence have a limited impact. It is important to note that these types of alerts are distinct from electronic triggers of abnormal test results, which have been successful in reducing delays in follow‐up care.…”

Estratificação De Risco Para Tromboembolismo Venoso Em Pacientes De Um Hospital Público Do Distrito Federal

“…O TEV é um evento muitas vezes silencioso, que não só impõe substancial carga socioeconômica aos sistemas de saúde, mas também é responsável por gerar situações debilitantes para a saúde, tais como aumento da morbimortalidade, incapacidade e diminuição da qualidade de vida (13) . De acordo com evidências científicas, um em cada seis casos de tromboembolismo poderiam ser evitados (14) .…”

“…A avaliação do risco de TEV representa um importante indicador de qualidade dos serviços de saúde (15)(16) . A padronização de modelos de estratificação de risco é um dos principais pontos que estimulam o cenário de pesquisa, visando a adequação da profilaxia centrada no indivíduo e a otimização entre o processo de estratificação e a implementação de medidas preventivas (14) .…”

Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing

“…Для аудита назначений АК была использована система автоматизации клинических руководств и аудита лечения (САКРАЛ), разработанная ранее в ММЦ. Принципы ее работы описаны в предыдущих публикациях [14,16]. Модуль «Антикоагулянтная терапия у пациентов с венозными тромбоэмболиями и фибрилляцией предсердий» был разработан на основе клинических рекомендаций Российского кардиологического общества [17] Для аудита антикоагулянтной терапии (АКТ) у пациентов с ФП и ТГВ клинические рекомендации были разделены на 3 раздела: 1) показания/противопоказания к назначению АК; 2) выбор АК и 3) режим дозирования АК (доза и длительность приема АК).…”

“…Увеличение до 90,6% охвата профилактикой внутригоспитальных венозных тромбоэмболических осложнений (ВГ-ВТЭО) описано при внедрении СППР "Advanced electronic alerts" (eAlerts) [13], которая автоматически формирует напоминание о необходимости тромбопрофилактики после внесения данных в электронную историю болезни. Описана отечественная СППР по профилактике ВГ-ВТЭО, внедрение которой в совокупности с организационными мероприятиями привело к увеличению охвата пациентов тромбопрофилактикой с 15% до 80% (p<0,0001) и статистически значимому сокращению частоты ВГ-ВТЭО [14].…”