Journal of the American Geriatrics Society · 2009
Development and pilot testing of computerized order entry algorithms for geriatric problems in nursing homes.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Colón-Emeric Cathleen S, Schmader Kenneth E, Twersky Jack, Kuchibhatla Maragantha, Kellum Sally, Weinberger Morris
Аннотация
OBJECTIVES: To develop order entry algorithms for five common nursing home problems and to test their acceptance, use, and preliminary effect on nine quality indicators and resource utilization.
DESIGN: Pre-post, quasi-experimental study.
SETTING: Two Department of Veterans Affairs nursing homes.
PARTICIPANTS: Randomly selected residents (N=265) with one or more target conditions and 42 nursing home providers.
INTERVENTION: Expert panels developed computerized order entry algorithms based on clinical practice guidelines. Each was displayed on a single screen and included an array of diagnostic and treatment options and means to communicate with the interdisciplinary team.
MEASUREMENTS: Medical records were abstracted for the 6 months before and after deployment for quality indicators and resource utilization.
RESULTS: Despite positive provider attitudes toward the computerized order entry algorithms, their use was infrequent and varied according to condition: falls (73.0%), fever (9.0%), pneumonia (8.0%), urinary tract infection (7.0%), and osteoporosis (3.0%). In subjects with falls, trends for improvements in quality measures were observed for six of the nine measures: measuring orthostatic blood pressure (17.5-30.0%, P=.29), reducing neuroleptics (53.8-75.0%, P=.27), reducing sedative-hypnotics (16.7-50.0%, P=.50), prescription of calcium (22.5-32.5%, P=.45), vitamin D (20.0-35.0%, P=.21), and external hip protectors (25.0-47.5%, P=.06). Little improvement was observed in the other conditions (documentation of vital signs, physical therapy referrals, or reduction of benzodiazepines or antidepressants). There was no change in resource utilization.
CONCLUSION: Computerized order entry algorithms were used infrequently, except for falls. Further study may determine whether their use leads to improved care.
DESIGN: Pre-post, quasi-experimental study.
SETTING: Two Department of Veterans Affairs nursing homes.
PARTICIPANTS: Randomly selected residents (N=265) with one or more target conditions and 42 nursing home providers.
INTERVENTION: Expert panels developed computerized order entry algorithms based on clinical practice guidelines. Each was displayed on a single screen and included an array of diagnostic and treatment options and means to communicate with the interdisciplinary team.
MEASUREMENTS: Medical records were abstracted for the 6 months before and after deployment for quality indicators and resource utilization.
RESULTS: Despite positive provider attitudes toward the computerized order entry algorithms, their use was infrequent and varied according to condition: falls (73.0%), fever (9.0%), pneumonia (8.0%), urinary tract infection (7.0%), and osteoporosis (3.0%). In subjects with falls, trends for improvements in quality measures were observed for six of the nine measures: measuring orthostatic blood pressure (17.5-30.0%, P=.29), reducing neuroleptics (53.8-75.0%, P=.27), reducing sedative-hypnotics (16.7-50.0%, P=.50), prescription of calcium (22.5-32.5%, P=.45), vitamin D (20.0-35.0%, P=.21), and external hip protectors (25.0-47.5%, P=.06). Little improvement was observed in the other conditions (documentation of vital signs, physical therapy referrals, or reduction of benzodiazepines or antidepressants). There was no change in resource utilization.
CONCLUSION: Computerized order entry algorithms were used infrequently, except for falls. Further study may determine whether their use leads to improved care.
Предметные рубрики MeSH
Accidental FallsAgedAged, 80 and overAlgorithmsChronic DiseaseCombined Modality TherapyCost-Benefit AnalysisEvidence-Based MedicineFeasibility StudiesFemaleFever of Unknown OriginFractures, SpontaneousHomes for the AgedHumansMaleMedical Order Entry SystemsNursing HomesOsteoporosisPatient Care TeamPneumonia, BacterialPractice Guidelines as TopicQuality Indicators, Health CareUrinary Tract Infections