Special ArticleComputerized Decision Support Based on a Clinical Practice Guideline Improves Compliance with Care Standards
Section snippets
Study Design
The effect of the Computer-Assisted Management Protocol on clinician compliance with guidelines was evaluated in a 6-month, randomized, controlled trial conducted at the Duke Family Medicine Center at Duke University Medical Center. Duke Family Medicine Center is a free-standing, primary care clinic that offers on site laboratory testing, radiology studies, and pharmacy services. It is also the primary outpatient clinic site for the Duke University Family Medicine Residency Program. In 1993,
Derivation of Compliance Data
Initially, 497 patients were identified for possible inclusion in the study based on a listing of diabetes on their electronic problem list and on having at least one encounter during the study period with a clinician enrolled in the study. Four hundred eighty-three charts (97.2%) were available for auditing. In 81 of the audited charts (16.8%), the diagnosis of diabetes incorrectly appeared on the patient's electronic problem list. Most of these incorrect diagnoses reflected errors in data
Discussion
The Computer-Assisted Management Protocol significantly improved clinician compliance with care guideline recommendations for diabetes. This finding demonstrates that a clinical practice guideline can be used to assist directly with patient management and validates the Computer-Assisted Management Protocol as a tool to assist clinicians in the management of diabetes mellitus by integrating medical knowledge at the point of care. While this study has shown that the Computer-Assisted Management
Acknowledgements
The authors wish to thank James Collins, PhD, for programming assistance; Kimberly S. H. Yarnall, MD., for suggestions concerning the clinical implementation of the Computer-Assisted Management Protocol; and Jonathan Prather, BS, for assistance with database queries.
This work was supported in part by grant 1-T15-LM07071 from the National Library of Medicine.
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