Decision Support System For Prevention Research Articles

Effectiveness of a computerized clinical decision support system for prevention of glucocorticoid-induced osteoporosis

Glucocorticoids are widely used for a variety of diseases, but the prevention of glucocorticoid-induced osteoporosis is sometimes neglected. Therefore, the effectiveness of a computerized clinical decision support system (CDSS) to improve the performance rate of preventive care for glucocorticoid-induced osteoporosis was evaluated. We conducted a prospective cohort study of outpatients who used glucocorticoids for three months or longer and who met the indication for preventive care based on a guideline. The CDSS recommended bisphosphonate (BP) prescription and bone mineral density (BMD) testing based on the risk of osteoporosis. The observation period was one year (phase 1: October 2017–September 2018) before implementation and the following one year (phase 2: October 2018–September 2019) after implementation of the CDSS. Potential alerts were collected without displaying them during phase 1, and the alerts were displayed during phase 2. We measured BP prescriptions and BMD testing for long-term prescription of glucocorticoids. A total of 938 patients (phase 1, 457 patients; phase 2, 481 patients) were included, and the baseline characteristics were similar between the phases. The median age was 71 years, and men accounted for 51%. The primary disease for prescription of glucocorticoids was rheumatic disease (28%), followed by hematologic diseases (18%). The prevalence of patients who needed an alert for BP prescription (67% vs. 63%, P = 0.24) and the acceptance rate of BP prescription (16% vs. 19%, P = 0.33) were similar between the phases. The number of patients who had orders for BMD testing was significantly increased (4% vs. 24%, P < 0.001) after CDSS implementation. The number of patients who needed an alert for BMD testing was significantly decreased from 93% in phase 1 to 87% in phase 2 (P = 0.004). In conclusion, the CDSS significantly increased BMD testing in patients with a higher risk of glucocorticoid-induced osteoporosis, but did not increase BP prescription.

Correlation between precipitation and orography - key element of the Spatial Decision Support System for Prevention and Management of Floods in the Firiza Basin (Northwest Romanian Carpathians)

Correlation between precipitation and orography - key element of the Spatial Decision Support System for Prevention and Management of Floods in the Firiza Basin (Northwest Romanian Carpathians)

A decision support system for prevention and costing of occupational injuries

Shrinking budgets and decreasing economic growth force accident insurance institutions to focus on cost reduction programmes as well as on prevention measures. For this reason, we developed sophisticated decision support systems (DSSs) from 2001 to 2012 during three projects for the main of the four largest Austrian accident insurance institutions (Allgemeine Unfallversicherungsanstalt, AUVA), to support their policy makers three-fold. First, we apply complex calculation schemes with an underlying population model to predict short-term and long-term occupational accident costs on an individual case basis for the AUVA using micro-simulation. Second, a further analysis of these costs allows AUVA policy makers to define risk groups which is essential to derive prevention programmes and their corresponding budgets (e.g., utilization of personal protective equipment, improvement of transportation safety, enhancement of safe driving). Third, we reveal possible improvements in collecting and structuring data for the AUVAs data warehouse for better forecasting of subsequent occupational accident costs and the underlying risk groups. Beyond the focus on AUVA interests, we integrated main cost components for companies where casualties are working (e.g., continued remuneration) and for the economy (loss in productivity for professional/non-professional work, sickness benefit). As a main result of our DSS for all three projects from 2001 to 2012, protection clothes or specific timing of working breaks decrease costly accidents. The results of the first two project periods (2001-2005) helped reduce risks of falling, while the third project (2011-2012) pointed out to focus on traffic injuries in the next years. In the future, AUVA should focus on prevention strategies in the following industries: preparatory site operations, building installation, and other finishing trades.

A decision support system for prevention and costing of occupational injuries

A decision support system for prevention and costing of occupational injuries

A clinical decision support system for prevention of venous thromboembolism: effect on physician behavior.

Computer-based clinical decision support systems (CDSSs) have been promoted for their potential to improve quality of health care. However, given the limited range of clinical settings in which they have been tested, such systems must be evaluated rigorously before widespread introduction into clinical practice. To determine whether presentation of venous thromboembolism prophylaxis guidelines using a CDSS increases the proportion of appropriate clinical practice decisions made. Time-series study conducted between December 1997 and July 1999. Orthopedic surgery department of a teaching hospital in Paris, France. A total of 1971 patients who underwent orthopedic surgery. A CDSS designed to provide immediate information pertaining to venous thromboembolism prevention among surgical patients was integrated into daily medical practice during three 10-week intervention periods, alternated with four 10-week control periods, with a 4-week washout between each period. Proportion of appropriate prescriptions ordered for anticoagulation, according to preestablished clinical guidelines, during intervention vs control periods. Physicians complied with guidelines in 82.8% (95% confidence interval [CI], 77.6%-87.1%) of cases during control periods and in 94.9% (95% CI, 92.5%-96.6%) of cases during intervention periods. During each intervention period, the appropriateness of prescription increased significantly (P<.001). Each time the CDSS was removed, physician practice reverted to that observed before initiation of the intervention. The relative risk of inappropriate practice decisions during control periods vs intervention periods was 3.8 (95% CI, 2.7-5.4). In our study, implementation of clinical guidelines for venous thromboembolism prophylaxis through a CDSS used routinely in an orthopedic surgery department and integrated into the hospital information system changed physician behavior and improved compliance with guidelines. JAMA. 2000;283:2816-2821