AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
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Errors in clinical research databases are common but relatively little is known about their characteristics and optimal detection and prevention strategies. We have analyzed data from several clinical research databases at a single academic medical center to assess frequency, distribution and features of data entry errors. Error rates detected by the double-entry method ranged from 2.3 to 26.9%. ⋯ Error detection based on data constraint failure significantly underestimated total error rates and constraint-based alarms integrated into the database appear to prevent only a small fraction of errors. Many errors were non-random, organized in special and cognitive clusters, and some could potentially affect the interpretation of the study results. Further investigation is needed into the methods for detection and prevention of data errors in research.
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AMIA Annu Symp Proc · Nov 2008
Application of statistical process control methods to monitor guideline adherence: a case study.
Control charts are tools from the field of statistical process control for visualizing the longitudinal development of quality indicators, and detecting whether the underlying process is changing. They have been used in critical care and disease management settings to monitor and improve patient outcomes. This paper investigates the application of control charts to monitor adherence to clinical practice guidelines by healthcare professionals. ⋯ Guideline adherence increased in clinics that started using decision support. A gradual drop in adherence was seen in clinics that continued using decision support over a longer period. Control charts are more sensitive to detect changes in adherence than summary comparisons in before-after designs.
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AMIA Annu Symp Proc · Nov 2008
Medical exceptions to decision support: a tool to identify provider misconceptions and direct academic detailing.
Clinical decision support can be used to capture the medical exceptions that justify deviations from guideline-based care. Peer review of this data is a potentially valuable and efficient means of identifying physician misconceptions or gaps in the medical knowledge base. Our early experience performing peer review on medical exceptions recorded through computerized point-of-care alerts shows that most medical exceptions were legitimate. Twelve percent of exceptions were inappropriate and 10% involved areas of considerable medical uncertainty.
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AMIA Annu Symp Proc · Jan 2008
Automatic pre-hospital vital signs waveform and trend data capture fills quality management, triage and outcome prediction gaps.
Trauma Triage errors are frequent and costly. What happens in pre-hospital care remains anecdotal because of the dual responsibility of treatment (resuscitation and stabilization) and documentation in a time-critical environment. ⋯ Automated means of data collection introduced the potential for more accurate and objective reporting of patient vital signs helping in evaluating quality of care and establishing performance indicators and benchmarks. Addition of novel and existing non-invasive monitors and waveform analyses could make the pulse oximeter the decision aid of choice to improve trauma patient triage.
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AMIA Annu Symp Proc · Jan 2008
Comparative StudyPhysicians' attitudes towards copy and pasting in electronic note writing.
The ability to copy and paste text within computerized physician documentation facilitates electronic note writing but may affect the quality of physician notes and patient care. Little is known about physicians' collective experience with the copy and paste function (CPF). We surveyed resident and faculty physicians within two affiliated academic medical centers in order to describe physicians' CPF use, perceptions of its impact on notes and patient care, and opinions regarding its future use.