临床决策支持 International Clinical Decision Support Standards(1).pptVIP

What I Did on my (Summer) Holiday:International Clinical Decision Support Standards Robert A. Jenders, MD, MS, FACP Associate Professor, Department of Medicine Cedars-Sinai Medical Center University of California, Los Angeles USA Co-Chair, Clinical Decision Support Technical Committee, HL7 21 February 2004 Overview: Clinical Decision Support Standards Part A: Computable Clinical Guidelines Part B: Arden Syntax and Related Issues I. Rationale for Guidelines:Evidence of Poor Performance USA: Only 54.9% of adults receive recommended care for typical conditions community-acquired pneumonia: 39% asthma: 53.5% hypertension: 64.9% McGlynn EA, Asch SM, Adams J et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635-2645. Delay in adoption: 10+ years for adoption of thrombolytic therapy Antman EM, Lau J, Kupelnick B et al. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA 1992;268(2):240-8. Rationale for Guidelines: What are they? “Systematically developed statements to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances.” (Field MJ, Lohr KN eds. Clinical Practice Guidelines: Directions for a New Program. IOM. Washington, DC: NAP, 1990) Guideline: Multi-step plan that unfolds over time Incorporate the latest (scientific) evidence Identify a standard of care Distribute to caregivers Rationale for Guidelines: Guideline Types Screening and prevention Diagnosis and prediagnosis management of patients Indications for use of surgical procedures Appropriate use of specific technologies and tests as part of clinical care Care of specific clinical conditions Field MJ, Lohr KN eds. Guidelines for Clinical Practice: From Development to Use. Washington, DC: NAP, 1992. Rationale for Guidelines: Addressing Knowledge Dissemination Ch