Use of a Computerized Decision Support System for Primary and Secondary Prevention of Work-Related MSD Disability

The present study evaluates the effectiveness of a decision support system used to evaluate and control physical job stresses and prevent re-injury of workers who have experienced or are concerned about work-related musculoskeletal disorders. The software program is a database that stores detailed job information such as standardized work data, videos, and upper-extremity physical stress ratings for over 400 jobs in the plant. Additionally, the database users were able to record comments about the jobs and related control issues. The researchers investigated the utility and effectiveness of the software by analyzing its use over a 20-month period. Of the 197 comments entered by the users, 25% pertained to primary prevention, 75% pertained to secondary prevention, and 94 comments (47.7%) described ergonomic interventions. Use of the software tool improved primary and secondary prevention by improving the quality and efficiency of the ergonomic job analysis process.     

Characterizing the Access of Clinical Decision Support Offered by Immunization Information System in Minnesota

Background: Healthy People 2020 aims to improve population health by increasing immunization rates to decrease vaccine-preventable infectious diseases. Amongst the many strategies, role of immunization information systems (IIS) are recognized by studies and taskforce reports. IIS are unique in their offering of clinical decision support for immunizations (CDSi) which are utilized by healthcare providers. Federal initiatives such as Meaningful Use (MU) and Affordable Care Act (ACA) aim to improve immunization rates through use of technology and expanding access to immunization services respectively. MU, the Electronic Health Record (EHR) incentive program includes use of IIS CDSi functionality as part of Stage 3. It is essential to understand access and use patterns of IIS CDSi, so as to utilize it better to improve immunization services.Objectives: To understand the utilization of clinical decision support for immunizations (CDSi) offered by immunization information system in Minnesota and to analyze the variability of its use across providers and EHR implementations.Methods: IIS in Minnesota (Minnesota Immunization Information Connection: MIIC) offers CDSi that is accessed through EHRs and branded as Alternate Access (AA). Data from MIIC and technical documents were reviewed to create details on organizations which implemented AA functionality. Data on EHR adoption in clinics and local health departments was obtained from Minnesota eHealth assessment reports. Data on access were tracked from January 2015 through mid-October 2015 through weekly specialized reports to track the queries by organization, volume and day of the week. Data were analyzed, findings were synthesized and reviewed with subject matter experts.Results: Currently 25 healthcare systems/organizations which represent 599 individual provider sites have implemented the AA functionality. Analysis of their EHR platform pointed to two EHRs (Epic and PH-Doc) as dominant products in Minnesota for private and public providers respectively. Use of this function was even across study time period. The query volume correlated to size of the organization, with the exception of an outlier organization with huge query count. Query was able to successfully locate a single matching record for 59% of searches, could not find a record for 5% and 31% resulted in blank/error and the match rates varied across health systems.Conclusion: High EHR adoption offers a great opportunity to promote use of IIS CDSi at point of care. Analysis did not track use at individual clinic level and how the queries were being generated. Additional research is needed to understand the provider level use of this CDSi and other organizational and technical factors which influence access to IIS. This is essential for IIS as they execute projects to improve population-level immunization rates, plan provider outreach and prioritize their system enhancements to meet federal requirements.     

A Decision Support Simulation Model for the Management of an Elective Surgery Waiting System

This paper describes the design of a simulation model to provide decision support for the scheduling of patients waiting for elective surgery in the public hospital system. Patients nominated for surgery by doctors are categorised by urgency and type of operation. The simulation model can be used as an operational tool to match hospital availability and patient need. It can also be used to report upon the performance of the system, and as a planning tool to compare the effectiveness of alternative policies in this multi-criteria decision environment.     

Parenteral Protein Decision Support System Improves Protein Delivery in Preterm Infants: A Randomized Clinical Trial

Background

Management of neonatal parenteral protein intake for preterm infants is challenging and requires daily modifications of the dose to account for the infant's postnatal age, birth weight, current weight, and the volume and protein concentration of concurrent enteral nutrition. The objective of this study was to create and evaluate the Parenteral Protein Calculator (PPC), a clinical decision support system to improve the accuracy of protein intake for preterm infants who require parenteral nutrition (PN).

Materials and Methods

We integrated the PPC into the computerized provider order entry system and tested it in a randomized controlled trial (routine or PPC). Infants were eligible if they were ≤3 days old, had a birth weight ≤1500 g, and had no inborn error of metabolism. The primary outcome was the appropriate total protein intake, defined as target protein dose ±0.5 g/kg.

Results

We randomly allocated 42 infants for 221 PN days in the control group and 211 in the PPC group. Total protein intake in the PPC group was more accurate as compared with the control group (appropriate protein dosing: odds ratio = 5.8; 95% CI, 2.7–12.4). Absolute deviation from protein target was 0.41 g/kg (0.24–0.58) lower in the PPC group.

Conclusion

The PPC improved appropriate protein dosing for premature infants receiving PN. Further studies are needed to test whether clinical decision support systems will reduce uremia and improve growth and to replicate similar findings in the cases of other PN nutrients.     

决策支持系统在医院应用中存在的问题分析

目的通过对目前医院统计信息决策支持服务应用中的问题进行分析,提出医院DSS(Decision Support System,决策支持系统)解决方案应当注意的问题。方法以目前的统计信息服务为起点,归纳存在的问题,并通过对DSS结构中各部分的问题分析,提出医院DSS设计应注意的问题。结果从数据资源、数据分析和数据表达三个方面对DSS设计方案提出了需要注意的问题及其解决方法。结论通过对医院信息架构、管理方式、技术环境等方面的一些改造,才能形成适合于DSS运作的环境。     

基于数据挖掘和决策支持的医疗质量分析

提出了在医疗质量持续改进策略中使用数据挖掘技术对医疗质量指标进行分析．特别是使用决策树分析方法对某医院8405例出院病人进行了数据挖掘分析，得出影响病人死亡率的几个重要因素。这些因素分别为：住院天数、疾病种类、所在科室以及年龄，并以决策树图形方式揭示了这些因素与病人死亡率的关系。同时，为了分析和监控医院医疗指标的变化趋势，我们开发了医疗质量决策支持系统，包括医疗质量持续改进的指导原则和方法。将来计划把支持全院医疗质量持续改进（CQI）的其他医疗质量指标纳入到软件系统中，并将质量决策支持系统与医院HIS医生工作站软件进行集成。     

乡镇卫生院医疗器械临床使用安全管理

本文通过对12家乡镇卫生院设备及人员配置的调查,分析了其存在的不足及原因,并提出了乡镇卫生院的医疗器械临床使用安全管理的对策。     

医院管理决策支持系统的构建思路

目的通过对医院决策支持系统实施中的问题进行分析,提出医院决策支持系统的构建思路。方法以目前大多数医院实施决策支持系统中存在的错误倾向为起点,归纳分析存在的问题,并提出构建思路。结果实施决策系统中存在着未充分考虑用户需求、基础数据质量不高、数据分析智能化程度不足等问题。结论通过采纳统一认识、合理规划、分步实施、持续改进等构建思路,可以提高系统实施效率和质量。     

Developing an International Register of Clinical Prediction Rules for Use in Primary Care: A Descriptive Analysis

PURPOSE

We describe the methodology used to create a register of clinical prediction rules relevant to primary care. We also summarize the rules included in the register according to various characteristics.

METHODS

To identify relevant articles, we searched the MEDLINE database (PubMed) for the years 1980 to 2009 and supplemented the results with searches of secondary sources (books on clinical prediction rules) and personal resources (eg, experts in the field). The rules described in relevant articles were classified according to their clinical domain, the stage of development, and the clinical setting in which they were studied.

RESULTS

Our search identified clinical prediction rules reported between 1965 and 2009. The largest share of rules (37.2%) were retrieved from PubMed. The number of published rules increased substantially over the study decades. We included 745 articles in the register; many contained more than 1 clinical prediction rule study (eg, both a derivation study and a validation study), resulting in 989 individual studies. In all, 434 unique rules had gone through derivation; however, only 54.8% had been validated and merely 2.8% had undergone analysis of their impact on either the process or outcome of clinical care. The rules most commonly pertained to cardiovascular disease, respiratory, and musculoskeletal conditions. They had most often been studied in the primary care or emergency department settings.

CONCLUSIONS

Many clinical prediction rules have been derived, but only about half have been validated and few have been assessed for clinical impact. This lack of thorough evaluation for many rules makes it difficult to retrieve and identify those that are ready for use at the point of patient care. We plan to develop an international web-based register of clinical prediction rules and computer-based clinical decision support systems.     

乌司他丁治疗重症肺炎的临床疗效分析

目的分析乌司他丁对重症肺炎的治疗效果。方法选取在2016年2月—2019年2月间因重症肺炎在本院就诊治疗的114例患者作为本研究的被选取对象,为保障本研究的顺利进行将所有被选取对象随机进行分组处理,分别为治疗组(57例)与对照组(57例)。其中对照组患者在入院后应用比阿培南等常规药物进行治疗,治疗组患者则在常规药物治疗的基础上加用乌司他丁。本研究将通过比较两组被选取对象的治疗效果和治疗前后的各项血清炎性因子水平,分析乌司他丁对重症肺炎患者的治疗效果。结果在治疗前,两组患者的CRP、PCT和TNF-α等血清炎性因子指标差异无统计学意义(P>0.05);在治疗后,治疗组患者的CRP、PCT和TNF-α等血清炎性因子指标均要低于对照组,差异有统计学意义(P<0.05),且治疗组患者的治疗有效率也要高于对照组,P<0.05,差异有统计学意义。结论乌司他丁在重症肺炎患者的治疗过程中效果显著,能够有效的降低患者的各项血清炎性因子指标。     

临床决策支持知识库研究

目的 运用知识管理的理念和方法,探讨切合实际应用的临床决策支持知识库概念模型,使医院能够通过知识管理提升其核心竞争力.方法收集国内外相关资料,系统化研究及分析具有人工智能的临床决策支持知识库的框架.结果实施医院知识管理的关键就是必须建立一个动态的,并具有自我学习能力的临床决策支持知识库,该知识库不仅需要通过医院信息系统收集传统的医学知识,而且需要建立用于临床指南等的标准医学知识收集的引擎和隐性知识转化模型,并嵌入智能化工具,通过知识库的自我学习功能,保证其动态更新和智能化的临床决策支持能力.结论医院知识库创建过程实质也是医院价值的创造过程,智能化的临床决策支持知识库开发不仅涉及知识的收集和处理,还包括知识的表达,人工智能技术的嵌入和各种规则、条件及分类方法等的应用,有待进一步研究.     

基于HIS的医院管理决策支持系统设计研究

目的：建立基于HIS的决策支持系统,增强管理者的决策能力。方法：通过对系统建模并编程,对内部数据和外部数据进行整合、归类、分析。结果：通过多维在线分析工具实现辅助决策,极大地方便了管理者,增强了决策的科学化和实效性。结论：提出了建立医院决策支持系统的基本方法,为进一步的研究奠定了基础。