1. Evidence-based guidelines and decision support services: A discussion and evaluation in triple assessment of suspected breast cancer.
- Author
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Patkar, V., Hurt, C., Steele, R., Love, S., Purushotham, A., Williams, M., Thomson, R., and Fox, J.
- Subjects
COMPUTERS in medicine ,MEDICAL care ,ONCOLOGY ,BREAST cancer ,PATIENTS ,BREAST tumor diagnosis ,RESEARCH ,RESEARCH methodology ,EVIDENCE-based medicine ,EVALUATION research ,DECISION support systems ,MEDICAL protocols ,COMPARATIVE studies ,CROSSOVER trials - Abstract
Widespread health service goals to improve consistency and safety in patient care have prompted considerable investment in the development of evidence-based clinical guidelines. Computerised decision support (CDS) systems have been proposed as a means to implement guidelines in practice. This paper discusses the general concept in oncology and presents an evaluation of a CDS system to support triple assessment (TA) in breast cancer care. Balanced-block crossover experiment and questionnaire study. One stop clinic for symptomatic breast patients. Twenty-four practising breast clinicians from United Kingdom National Health Service hospitals. A web-based CDS system. Clinicians made significantly more deviations from guideline recommendations without decision support (60 out of 120 errors without CDS; 16 out of 120 errors with CDS, P < 0.001). Ignoring minor deviations, 16 potentially critical errors arose in the no-decision-support arm of the trial compared with just one (P = 0.001) when decision support was available. Opinions of participating clinicians towards the CDS tool became more positive after they had used it (P < 0.025). The use of decision support capabilities in TA may yield significant measurable benefits for quality and safety of patient care. This is an important option for improving compliance with evidence-based practice guidelines. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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