Bmc Med Inform Decis
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Bmc Med Inform Decis · Jan 2013
Towards plug-and-play integration of archetypes into legacy electronic health record systems: the ArchiMed experience.
The dual model approach represents a promising solution for achieving semantically interoperable standardized electronic health record (EHR) exchange. Its acceptance, however, will depend on the effort required for integrating archetypes into legacy EHR systems. ⋯ Our experiences show that archetypes should be customized based on the planned application scenario before their integration. This would allow problematic structures to be dissolved and irrelevant optional archetype nodes to be removed. For customization of archetypes, openEHR templates or specialized archetypes may be employed. Gaps in the data types or terminological features supported by an EHR system will often not preclude integration of the relevant archetypes. More work needs to be done on the usability of the generated forms.
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Bmc Med Inform Decis · Jan 2013
ReviewSystematic review of clinical decision support interventions with potential for inpatient cost reduction.
Healthcare costs are increasing rapidly and at an unsustainable rate in many countries, and inpatient hospitalizations are a significant driver of these costs. Clinical decision support (CDS) represents a promising approach to not only improve care but to reduce costs in the inpatient setting. The purpose of this study was to systematically review trials of CDS interventions with the potential to reduce inpatient costs, so as to identify promising interventions for more widespread implementation and to inform future research in this area. ⋯ Significantly more research is required on the impact of clinical decision support on inpatient costs. In particular, there is a remarkable gap in the availability of cost effectiveness studies required by policy makers and decision makers in healthcare systems.
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Bmc Med Inform Decis · Jan 2013
Review Case ReportsThe challenges of implementing a telestroke network: a systematic review and case study.
The use of telemedicine in acute stroke care can facilitate rapid access to treatment, but the work required to embed any new technology into routine practice is often hidden, and can be challenging. We aimed to collate recommendations and resources to support telestroke implementation. ⋯ Information to guide telestroke implementation is sparse, but available. By using multiple sources of data, sufficient information was collated to construct a web-based toolkit detailing implementation tasks, resources and challenges in the development of a telestroke system for assessment and thrombolysis delivery in acute care. The toolkit is freely available online.
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Bmc Med Inform Decis · Jan 2013
Randomized Controlled TrialA tailored, dialogue-based health communication application for patients with chronic low back pain: study protocol of a randomised controlled trial.
Chronic low back pain is a common chronic condition whose treatment success can be improved by active involvement of patients. Patient involvement can be fostered by web-based applications combining health information with decision support or behaviour change support. These so-called Interactive Health Communication Applications (IHCAs) can reach great numbers of patients at low financial cost and provide information and support at the time, place and learning speed patients prefer. However, high attrition often seems to decrease the effects of web-based interventions. Tailoring content and tone of IHCAs to the individual patient ́s needs might improve usage and therefore effectiveness. This study aims to evaluate a tailored IHCA for people with chronic low back pain combining health information with decision support and behaviour change support. ⋯ IHCAs can be a suitable way to promote knowledge about chronic low back pain and self-management competencies. Results of the study can increase the knowledge on how to develop IHCAs which are more useful and effective for people suffering from chronic low back pain.
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Bmc Med Inform Decis · Jan 2013
Comparative StudyMeasuring preferences for analgesic treatment for cancer pain: how do African-Americans and Whites perform on choice-based conjoint (CBC) analysis experiments?
Conjoint Analysis (CA) can serve as an important tool to study health disparities and unique factors underlying decision-making in diverse subgroups. However, methodological advancements are needed in exploiting this application of CA. We compared the internal and external predictive validity and inter-temporal stability of Choice-based-Conjoint (CBC) analysis between African-Americans and Whites in the clinical context of preferences for analgesic treatment for cancer pain. ⋯ While we found slight group differences, overall the internal and external predictive validity of CBC was comparable between African-Americans and Whites. We discuss some areas to investigate and improve internal and external predictive validity of CBC experiments.