Abstract:
BACKGROUND:Evidence-based therapy for heart failure remains underutilized at hospital discharge, particularly for patients with heart failure who are hospitalized for another cause. We developed clinical decision support (CDS) to recommend an angiotensin converting enzyme (ACE) inhibitor during hospitalization to promote its continuation at discharge. The CDS was designed to be implemented in both interruptive and non-interruptive versions. OBJECTIVES:To compare the effectiveness and implementation of interruptive and non-interruptive versions of a CDS to improve care for heart failure. METHODS:Hospitalizations of patients with reduced ejection fraction were pseudo-randomized to deliver interruptive or non-interruptive CDS alerts to providers based on even or odd medical record number. We compared discharge utilization of an ACE inhibitor or angiotensin receptor blocker (ARB) for these two implementation approaches. We also assessed adoption and implementation fidelity of the CDS. RESULTS:Of 958 hospitalizations, interruptive alert hospitalizations had higher rates of discharge utilization of ACE inhibitors or ARBs than non-interruptive alert hospitalizations (79.6% vs. 74.2%, p = 0.05). Utilization was higher for interruptive alert versus non-interruptive alert hospitalizations which were principally for causes other than heart failure (79.8% vs. 73.4%; p = 0.05) but no difference was observed among hospitalizations with a principal heart failure diagnosis (85.9% vs.81.7%; p = 0.49). As compared to non-interruptive hospitalizations, interruptive alert hospitalizations were more likely to have had: an alert with any response (40.6% vs. 13.1%, p < 0.001), contraindications reported (33.1% vs 11.3%, p < 0.001), and an ACE inhibitor ordered within twelve hours of the alert (17.6% vs 10.3%, p < 0.01). The response rate for the interruptive alert was 1.7%, and a median (25th, 75th percentile) of 14 (5,32) alerts were triggered per hospitalization. CONCLUSIONS:A CDS implemented as an interruptive alert was associated with improved quality of care for heart failure. Whether the potential benefits of CDS in improving cardiovascular care were worth the high burden of interruptive alerts deserves further consideration. CLINICALTRIALS. GOV IDENTIFIER:NCT02858674.
journal_name
Int J Med Informjournal_title
International journal of medical informaticsauthors
Blecker S,Austrian JS,Horwitz LI,Kuperman G,Shelley D,Ferrauiola M,Katz SDdoi
10.1016/j.ijmedinf.2019.103956subject
Has Abstractpub_date
2019-11-01 00:00:00pages
103956eissn
1386-5056issn
1872-8243pii
S1386-5056(19)30462-9journal_volume
131pub_type
杂志文章abstract:PURPOSE:Many criteria have been developed to rate the quality of online health information. To effectively evaluate quality, consumers must use quality criteria that can be reliably assessed. However, few instruments have been validated for inter-rater agreement. Therefore, we assessed the degree to which two raters co...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2005.02.002
更新日期:2005-08-01 00:00:00
abstract::Telemedicine systems have been considered as a necessary measure to alleviate the shortfall in skilled medical specialists in developing countries. However, the obvious challenge is whether clinicians are willing to use this technological innovation, which has aided medical practice globally. One factor which has rece...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2017.05.008
更新日期:2017-08-01 00:00:00
abstract:PURPOSE:The purpose of this qualitative study was to improve understanding of family caregivers' use of Web-based intervention support by integrating three theoretical models. The study applied the Anderson's model of health service utilization, Venkatesh's theory of technology acceptance, and Chatman's and Wilson's in...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2011.08.010
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVES:A number of studies have been conducted to identify the self-care strategies that are used by persons living with chronic illnesses to manage their symptoms, but little work has been done to identify the primary information source for these self-care strategies. METHODS:We conducted an anonymous online surv...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2017.12.002
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVES:To examine whether simulation training enhanced self-efficacy of physicians and nurses who work in the outpatient setting to use electronic medical records, and whether the training changed their perceptions about the importance of electronic medical records (EMRs) in helping patients and improving patients'...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2015.02.003
更新日期:2015-06-01 00:00:00
abstract:PURPOSE:The increasing usage of high throughput sequencing in personalized medicine brings new challenges to the realm of healthcare informatics. Patient records need to accommodate data of unprecedented size and complexity as well as keep track of their production process. In this work we present a solution for integr...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2018.10.007
更新日期:2018-12-01 00:00:00
abstract::A computer system of PCs, workstations, minicomputers etc. connected together via a local area network or wide area network represents a large pool of computational power. Our aim is to use this power for the implementation of an E(3) (efficiency, effectiveness, efficacy) medical decision support system, which can be ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(00)00086-1
更新日期:2000-09-01 00:00:00
abstract:CONTEXT:Data mining (DM) provides the methodology and technology needed to transform huge amounts of data into useful information for decision making. It is a powerful process employed to extract knowledge and discover new patterns embedded in large data sets. Data mining has been increasingly used in medicine, particu...
journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2016.09.005
更新日期:2017-01-01 00:00:00
abstract::Store-and-forward telemedicine, using e-mail to send clinical data and digital images, offers a low-cost alternative for physicians in developing countries to obtain second opinions from specialists. To explore the potential usefulness of this technique, 91 chest X-ray images were photographed using a digital camera a...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2003.10.002
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:ERAS protocol compliance is traditionally measured and reported as 'items compliance' which is retrospective longitudinal adherence of all patients to an index element. Reporting in this manner is restrictive and cannot impact care in real-time. In order to modify behavior effectively and instantaneously, we...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2020.104194
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Trauma resuscitation involves multidisciplinary teams under surgical leadership in most US trauma centers. Because many trauma centers have also incorporated emergency department (ED) physicians, shared and cross-disciplinary leadership structures often occur. Our study identifies leadership structures and e...
journal_title:International journal of medical informatics
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ijmedinf.2011.01.004
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVE:The work proposed a novel bit-rate-reduced approach for reducing the memory required to store a remote diagnosis and rapidly transmission it. METHOD:In the work, an 8x8 Discrete Cosine Transform (DCT) approach is adopted to perform subband decomposition. Modified set partitioning in hierarchical trees (SPIHT...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2006.07.002
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVE:Ontology in clinical domains is becoming a core research field in the realm of medical informatics. The objective of this study is to explore the potential role of formal concept analysis (FCA) in a context-based ontology building support in a clinical domain (e.g. cardiovascular medicine here). METHODOLOGY:...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(03)00092-3
更新日期:2003-08-01 00:00:00
abstract:OBJECTIVE:To obtain an overview of study designs and study methods used in research evaluating IT in health care, to present a list of quality criteria by which all kinds of reported evaluation studies on IT systems in health care can be assessed, and to assess the quality of reported evaluation studies on IT in health...
journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2006.11.009
更新日期:2008-01-01 00:00:00
abstract::With the growing concern about health issues and the emergence of online communities based on user-generated content (UGC), more and more people are participating in online health communities (OHCs) to exchange opinions and health information. This paper aims to examine whether and how male and female users behave dif...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2017.12.019
更新日期:2018-03-01 00:00:00
abstract::In this paper, we present a model that describes the stages of the implementation of an information system in a health care organization. The model offers no explanation of the implementation process but rather describes in a cyclic order the domains that are relevant when implementing a system. The model offers thus ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(98)00142-7
更新日期:1998-10-01 00:00:00
abstract::The Health Service Reform Programme in Ireland will be the biggest change ever seen in the health service. This programme will be dependent on information structures that provide appropriate and timely information. The Nursing Informatics Project Team in the Mater Misericordiae University Hospital, Dublin is in the pr...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2005.07.041
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:Recent developments in positioning systems and telecommunications have provided the technology needed for the development of location aware medical applications. We developed a system, named EmerLoc, which is based upon this technology and uses a set of sensors that are attached to the patient's body, a micr...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2006.07.010
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:Poorly designed infusion pumps can lead to user errors and adverse incidents. Therefore, assessments of their usability and performance that can inform managerial decisions about the selection of appropriate medical devices are essential. OBJECTIVE:This study aimed to identify design deficiencies and evalua...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2019.07.011
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Predicting insulin-induced postprandial hypoglycemic events is critical for the safety of type 1 diabetes patients because an early warning of hypoglycemia facilitates correction of the insulin bolus before its administration. The postprandial hypoglycemic event counts can be lowered by reducing the size of ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2019.03.008
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:Our aim is to develop reliable descriptions of various seizure types, which will be used as a basis for decision support. We use expert opinions in this process. In this contribution we evaluate the inter-participant agreement in the selection of frequently occurring symptoms for the description of seizure ty...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(03)00047-9
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Building on initial work carried out by the Faculty of Clinical Informatics (FCI) in the UK, the creation of a national competency framework for Clinical Informatics is required for the definition of clinical informaticians' professional attributes and skills. We aimed to systematically review the academic l...
journal_title:International journal of medical informatics
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.ijmedinf.2020.104237
更新日期:2020-09-01 00:00:00
abstract:INTRODUCTION:Telehealth is an important tool for ensuring accessible healthcare access particularly over geographical distances. Videoconference and telephone are two common telehealth modalities, yet little is known as to the relative advantage of these modalities. Synthesizing evidence as to the impact of these modal...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2018.07.007
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:This paper presents Alzheed, a mobile application for monitoring patients with Alzheimer's disease at day centers as well as a set of design recommendations for the development of healthcare mobile applications. The Alzheed project was conducted at Day Center "Dorita de Ojeda" that is focused o...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2019.103972
更新日期:2019-11-01 00:00:00
abstract:UNLABELLED:The paper provides detailed descriptions of general practitioners (GPs') interactions, both with their computers and their patients, with the aim of facilitating the detailed understanding of how GPs use their computers while in consultation with patients. The focus is on the coordinated activities of the do...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2005.04.002
更新日期:2005-07-01 00:00:00
abstract:INTRODUCTION:Information extraction (IE) systems have been proposed in recent years to extract genic interactions from bibliographical resources. They are limited to single interaction relations, and have to face a trade-off between recall and precision, by focusing either on specific interactions (for precision), or g...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2009.03.005
更新日期:2009-12-01 00:00:00
abstract:PURPOSE:One of the main challenges of eHealth is semantic interoperability of health systems. But, this will only be possible if the capture, representation and access of patient data is standardized. Clinical data models, such as OpenEHR Archetypes, define data structures that are agreed by experts to ensure the accur...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2012.02.007
更新日期:2012-08-01 00:00:00
abstract:PURPOSE:Information Technologies and Knowledge-based Systems can significantly improve the management of complex distributed health systems, where supporting multidisciplinarity is crucial and communication and synchronization between the different professionals and tasks becomes essential. This work proposes the use o...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2010.01.012
更新日期:2010-05-01 00:00:00
abstract::An information revolution is underway which will have an impact on all sectors of society. It will fundamentally change national and international health systems. The global Internet is a key influence and will change the balance of power within and between healthcare professions, and between them and the general publ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(97)00106-8
更新日期:1998-02-01 00:00:00
abstract::Today, the economic and regulatory environment, involving activity-based and prospective payment systems, healthcare quality and risk analysis, traceability of the acts performed and evaluation of care practices, accounts for the current interest in clinical and hospital information systems. The structured gathering o...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2004.07.003
更新日期:2005-03-01 00:00:00