1
|
Liu Y, Deng Y, Li S, Wang-Ngai Chow F, Liu M, He N. Monitoring and detection of antibiotic residues in animal derived foods: Solutions using aptamers. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
2
|
Shen L, Wei X, Yin J, Haley DR, Sun Q, Lundborg CS. Interventions to optimize the use of antibiotics in China: A scoping review of evidence from humans, animals, and the environment from a One Health perspective. One Health 2022; 14:100388. [PMID: 35686150 PMCID: PMC9171522 DOI: 10.1016/j.onehlt.2022.100388] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 12/28/2022] Open
|
3
|
Coope C, Schneider A, Zhang T, Kadetz P, Feng R, Lambert H, Wang D, Oliver I, Michie S, Cabral C. Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis. BMJ Open 2022; 12:e056348. [PMID: 35338063 PMCID: PMC8961142 DOI: 10.1136/bmjopen-2021-056348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. METHODS Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). RESULTS Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. CONCLUSIONS Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.
Collapse
Affiliation(s)
- Caroline Coope
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Annegret Schneider
- Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Behaviour Change, University College London, London, UK
| | - Tingting Zhang
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Paul Kadetz
- Queen Margaret University, Institute for Global Health and Development, Edinburgh, UK
| | - Rui Feng
- Library, Anhui Medical University, Hefei, Anhui, China
| | - Helen Lambert
- Population Health Sciences, University of Bristol, Bristol, UK
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Isabel Oliver
- Field Service, National Infection Service, Public Health England National Infection Service, Salisbury, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Christie Cabral
- Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
4
|
Zhang YF, Gou L, Zhou TS, Lin DN, Zheng J, Li Y, Li JS. An ontology-based approach to patient follow-up assessment for continuous and personalized chronic disease management. J Biomed Inform 2017; 72:45-59. [PMID: 28676255 DOI: 10.1016/j.jbi.2017.06.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/23/2017] [Accepted: 06/30/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Chronic diseases are complex and persistent clinical conditions that require close collaboration among patients and health care providers in the implementation of long-term and integrated care programs. However, current solutions focus partially on intensive interventions at hospitals rather than on continuous and personalized chronic disease management. This study aims to fill this gap by providing computerized clinical decision support during follow-up assessments of chronically ill patients at home. METHODS We proposed an ontology-based framework to integrate patient data, medical domain knowledge, and patient assessment criteria for chronic disease patient follow-up assessments. A clinical decision support system was developed to implement this framework for automatic selection and adaptation of standard assessment protocols to suit patient personal conditions. We evaluated our method in the case study of type 2 diabetic patient follow-up assessments. RESULTS The proposed framework was instantiated using real data from 115,477 follow-up assessment records of 36,162 type 2 diabetic patients. Standard evaluation criteria were automatically selected and adapted to the particularities of each patient. Assessment results were generated as a general typing of patient overall condition and detailed scoring for each criterion, providing important indicators to the case manager about possible inappropriate judgments, in addition to raising patient awareness of their disease control outcomes. Using historical data as the gold standard, our system achieved a rate of accuracy of 99.93% and completeness of 95.00%. CONCLUSIONS This study contributes to improving the accessibility, efficiency and quality of current patient follow-up services. It also provides a generic approach to knowledge sharing and reuse for patient-centered chronic disease management.
Collapse
Affiliation(s)
- Yi-Fan Zhang
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Ling Gou
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Tian-Shu Zhou
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - De-Nan Lin
- Health Information Center, Shenzhen, China
| | - Jing Zheng
- Health Information Center, Shenzhen, China
| | - Ye Li
- Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jing-Song Li
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.
| |
Collapse
|
5
|
Honda H, Ohmagari N, Tokuda Y, Mattar C, Warren DK. Antimicrobial Stewardship in Inpatient Settings in the Asia Pacific Region: A Systematic Review and Meta-analysis. Clin Infect Dis 2017; 64:S119-S126. [DOI: 10.1093/cid/cix017] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
6
|
Li J, Li B, Zhang F, Sun Y. Urban and rural stroke mortality rates in China between 1988 and 2013: An age-period-cohort analysis. J Int Med Res 2017; 45:680-690. [PMID: 28415926 PMCID: PMC5536664 DOI: 10.1177/0300060516664241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate effects attributable to age, time period and birth cohort, on stroke mortality data from urban and rural regions in China between 1988 and 2013. Methods Mortality data were obtained from the Chinese Health Statistics Annual Report (1987–2001) and Chinese Health Statistics Yearbooks (2003–2014). Population data were obtained from population censuses (i.e. 1982, 1990, 2000 and 2010). Data were analysed using an age-period-cohort (APC) model and intrinsic estimation (IE) method. Results The age effect suggested that all older residents had higher stroke mortality risk than younger residents. Period effect showed that compared with figures for 1988, stroke mortality in 2013 was 1.8 times higher for urban regions and 2.4 times higher for rural regions. After controlling for age and period effects, cohorts born before the Chinese economic reform had a steady decline in stroke mortality. However, mortality rates increased and fluctuated in post-reform cohorts. Conclusions This APC-IE analysis identified a modest period effect with large age and cohort contributions to both the overall mortality and the disparity between urban and rural stroke mortality. Identifying early life and cumulative risk factors for stroke, improving equality in stroke prevention and care are needed to reduce the stroke mortality in China.
Collapse
Affiliation(s)
- Jingjing Li
- 1 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,4 Department of Epidemiology, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Boyang Li
- 2 Department of Public Affairs and Management, School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei Province, China
| | - Fengfan Zhang
- 3 School of Health and Medical Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yang Sun
- 2 Department of Public Affairs and Management, School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei Province, China
| |
Collapse
|
7
|
Zhang HH, Du Y, Liu W, Song SD, Zhao W, Huang GW, Wang HS. Effectiveness of Antibiotic Use Management in Tianjin (2011-2013): A Quasi-Experimental Study. Med Sci Monit 2017; 23:725-731. [PMID: 28179620 PMCID: PMC5317282 DOI: 10.12659/msm.899848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In this study we investigated changes in the status of antibiotic use in Tianjin since the implementation of the Antibiotic Stewardship Program (ASP) (2011-2013), as well as existing problems, strategies, and outcomes to promote rational clinical antibiotic use. MATERIAL AND METHODS A quasi-experimental study was performed to investigate situations of antibiotic use in secondary and tertiary general hospitals in Tianjin from April 2011 to 2013. Five major indicators were analyzed: percentage of antibiotic use in inpatient cases (%), antibacterial use density (AUD), proportion of prophylactic antibiotic application for type I surgical incision, compliance rate of medication administration 0.5-2.0 h before such procedures, and antibiotic prophylaxis for ≤24 h in patients receiving these surgeries. RESULTS There was a decrease in the percentage of antibiotic use across general hospitals (60.38% to 46.88%), in AUD (51.60% to 35.37%), and in the proportion of prophylactic antibiotic applications for type I incisions (86.67% to 25.08%). For patients undergoing these procedures, there was an increased compliance rate of medication administration of 0.5-2.0 h prior to surgery (86.38% to 100%), and of antibiotic prophylactic use for ≤24 h (40.30% to 96.37%). CONCLUSIONS Implementation of the ASP campaign has reduced irrational antibiotic use, promoted rational antibiotic use, and delayed antibiotic resistance.
Collapse
Affiliation(s)
- Hai-Hong Zhang
- School of Public Health, Tianjin Medical University, Tianjin, China (mainland)
| | - Yue Du
- School of Public Health, Tianjin Medical University, Tianjin, China (mainland)
| | - Wei Liu
- Department of Public Health, Tianjin Municipal Commission of Health and Family Planning, Tianjin, China (mainland)
| | - Shi-Duo Song
- Department of Infectious Diseases, The Second Hospital of Tianjin Medical University, Tianjin, China (mainland)
| | - Wen Zhao
- Department of Infectious Diseases, The Second Hospital of Tianjin Medical University, Tianjin, China (mainland)
| | - Guo-Wei Huang
- School of Public Health, Tianjin Medical University, Tianjin, China (mainland)
| | - He-Sheng Wang
- School of Public Health, Tianjin Medical University, Tianjin, China (mainland)
| |
Collapse
|
8
|
Wang HQ, Zhou TS, Zhang YF, Chen L, Li JS. Research and Development of Semantics-based Sharable Clinical Pathway Systems. J Med Syst 2015; 39:73. [PMID: 26071207 DOI: 10.1007/s10916-015-0257-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 06/02/2015] [Indexed: 12/14/2022]
Abstract
The clinical pathway (CP) as a novel medical management schema is beneficial for reducing the length of stay, decreasing heath care costs, standardizing clinical activities, and improving medical quality. However, the practicability of CPs is limited by the complexity and expense of adding the standard functions of electronic CPs to existing electronic medical record (EMR) systems. The purpose of this study was to design and develop an independent clinical pathway (ICP) system that is sharable with different EMR systems. An innovative knowledge base pattern was designed with separate namespaces for global knowledge, local knowledge, and real-time instances. Semantic web technologies were introduced to support knowledge sharing and intelligent reasoning. The proposed system, which was developed in a Java integrated development environment, achieved standard functions of electronic CPs without modifying existing EMR systems and integration environments in hospitals. The interaction solution between the pathway system and the EMR system simplifies the integration procedures with other hospital information systems. Five categories of transmission information were summarized to ensure the interaction process. Detailed procedures for the application of CPs to patients and managing exceptional alerts are presented by explicit data flow analysis. Compared to embedded pathway systems, independent pathway systems feature greater feasibility and practicability and are more advantageous for achieving the normalized management of standard CPs.
Collapse
Affiliation(s)
- Hua-Qiong Wang
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | | | | | | | | |
Collapse
|
9
|
Design and development of a medical big data processing system based on Hadoop. J Med Syst 2015; 39:23. [PMID: 25666927 DOI: 10.1007/s10916-015-0220-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
Secondary use of medical big data is increasingly popular in healthcare services and clinical research. Understanding the logic behind medical big data demonstrates tendencies in hospital information technology and shows great significance for hospital information systems that are designing and expanding services. Big data has four characteristics--Volume, Variety, Velocity and Value (the 4 Vs)--that make traditional systems incapable of processing these data using standalones. Apache Hadoop MapReduce is a promising software framework for developing applications that process vast amounts of data in parallel with large clusters of commodity hardware in a reliable, fault-tolerant manner. With the Hadoop framework and MapReduce application program interface (API), we can more easily develop our own MapReduce applications to run on a Hadoop framework that can scale up from a single node to thousands of machines. This paper investigates a practical case of a Hadoop-based medical big data processing system. We developed this system to intelligently process medical big data and uncover some features of hospital information system user behaviors. This paper studies user behaviors regarding various data produced by different hospital information systems for daily work. In this paper, we also built a five-node Hadoop cluster to execute distributed MapReduce algorithms. Our distributed algorithms show promise in facilitating efficient data processing with medical big data in healthcare services and clinical research compared with single nodes. Additionally, with medical big data analytics, we can design our hospital information systems to be much more intelligent and easier to use by making personalized recommendations.
Collapse
|
10
|
Wu H, Wang Y, Wu Y, Qiao J, Li H, Zheng S, Xia X, Cui S, Wang X, Xi M, Meng J, Yang B. Emergence of β-lactamases and extended-spectrum β-lactamases (ESBLs) producing Salmonella in retail raw chicken in China. Foodborne Pathog Dis 2015; 12:228-34. [PMID: 25658910 DOI: 10.1089/fpd.2014.1859] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
β-Lactamases and extended-spectrum β-lactamases (ESBLs) producing pathogenic bacteria were widely studied previously in China, but were seldom focused on foodborne Salmonella. In this study, an investigation concerning β-lactamases and ESBLs producing Salmonella recovered from retail raw chickens was performed. Sixty of 699 foodborne Salmonella isolates were detected as β-lactamases and ESBLs-producing ones that covered 12 Salmonella serotypes and exhibited different pulsed-field gel electrophoresis genotypes. Forty-four of 60 β-lactamases and ESBLs-producing strains were simultaneously resistant to ampicillin, amoxicillin/clavulanic acid, ceftiofur, ceftriaxone, and cefoxitin. The most commonly detected β-lactamases and ESBLs-encoding gene was bla(TEM-1) (n = 44), followed by bla(OXA-1) (n = 38), bla(CMY-2) (n = 29), bla(PSE-1-like) (n = 1), bla(CTX-M-3) (n = 16), and bla(CTX-M-15) (n = 1), respectively. Fourteen, 24, 21, and 1 isolates were detected simultaneously positive for 1, 2, 3, and 4 of the detected β-lactamases and ESBLs-encoding genes, respectively. A Salmonella strain simultaneously co-carrying bla(TEM-1), bla(OXA-1), bla(CMY-2), and bla(CTX-M-3) was first reported in the present study. Amino acid substitution of Trp244Cys/His247Leu was detected in PSE-1, Val218Asp in CMY-2, and Asp242Gly in CTX-M-15 enzymes, respectively. A difference was found among the amino acid sequences of the detected OXA-1, CMY-2, CTX-M, PSE-1, and TEM-1. The results demonstrated that β-lactamases and ESBLs were emerging and prevalent in foodborne Salmonella.
Collapse
Affiliation(s)
- Haiyun Wu
- 1 College of Food Science and Engineering, Northwest A&F University , Yangling, Shaanxi, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Hamilton KW, Gerber JS, Moehring R, Anderson DJ, Calderwood MS, Han JH, Mehta JM, Pollack LA, Zaoutis T, Srinivasan A, Camins BC, Schwartz DN, Lautenbach E. Point-of-prescription interventions to improve antimicrobial stewardship. Clin Infect Dis 2015; 60:1252-8. [PMID: 25595748 DOI: 10.1093/cid/civ018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Antimicrobial stewardship is pivotal to improving patient outcomes, reducing adverse events, decreasing healthcare costs, and preventing further emergence of antimicrobial resistance. In an era in which antimicrobial resistance is increasing, judicious antimicrobial use is the responsibility of every healthcare provider. Antimicrobial stewardship programs (ASPs) have made headway in improving antimicrobial prescribing using such "top-down" methods as formulary restriction and prospective audit with feedback; however, engagement of prescribers has not been fully explored. Strategies that include frontline prescribers and other unit-based healthcare providers have the potential to expand stewardship, both to augment existing centralized ASPs and to provide alternative approaches to perform stewardship at healthcare facilities with limited resources. This review discusses interventions focusing on antimicrobial prescribing at the point of prescription as well as a pilot project to engage unit-based healthcare providers in antimicrobial stewardship.
Collapse
Affiliation(s)
- Keith W Hamilton
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania
| | - Rebekah Moehring
- Division of Infectious Diseases, Duke University Medical Center Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina
| | - Deverick J Anderson
- Division of Infectious Diseases, Duke University Medical Center Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina
| | - Michael S Calderwood
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer H Han
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia
| | - Jimish M Mehta
- North American Medical Affairs, GlaxoSmithKline, Philadelphia, Pennsylvania
| | - Lori A Pollack
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theoklis Zaoutis
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania
| | - Arjun Srinivasan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard C Camins
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - David N Schwartz
- Division of Infectious Diseases, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia
| | | |
Collapse
|
12
|
Yin S, Song Y, Bian Y. Does the Essential Medicines Policy Succeed in China? Empirical Study on Rational Medicine Use in Primary Health Care Institutions. Ther Innov Regul Sci 2014; 48:689-695. [PMID: 30227464 DOI: 10.1177/2168479014527748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated outpatient prescription medicines use in primary health care institutions to evaluate the impact of the essential medicines policy on rational medicines use. Data were collected from primary health care institutions in 4 province-level areas of different socioeconomic status in China. Around the policy implementation, the numbers of various medicines used per prescription were compared by t test and 1-way analysis of variance, and the proportions of prescriptions with antibiotics, injections, or hormones were compared by chi-square test. After the policy implementation, the numbers of all medicines and antibiotics used per prescription dropped, and the number of essential medicines used per prescription increased in all 4 areas. The percentage of prescriptions with injections declined in all 4 areas, but the percentages of prescriptions with antibiotics or hormones witnessed different status in different areas. To a certain degree, the essential medicines policy in China has taken effect on rational medicines use but needs development.
Collapse
Affiliation(s)
- Shi Yin
- 1 State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Yan Song
- 1 State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Ying Bian
- 1 State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| |
Collapse
|
13
|
Yang P, Cao Y, Liu D, Bai Y, Pan F, Xu Y. The effect of electronic medical record application on the length of stay in a Chinese general hospital: a department- and disease-focused interrupted time-series study. J Med Syst 2014; 38:53. [PMID: 24760225 DOI: 10.1007/s10916-014-0053-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
A key purpose of electronic medical records (EMR) introduced in medical institutions is to improve work efficiency. The average length of stay (LOS) is just an important indicator to evaluate work efficiency of medical care in hospitals. Recently, there have been reports about effects of EMR application on LOS in medical institutions, but they have been mostly based on the overall analysis of a region or a hospital and not of specific clinical departments and diseases or based on longer time periods. Therefore, in this study, we selected four clinical departments and four diseases with the largest number of inpatients from January 2004 to December 2012 in a Chinese 3A general hospital and used an interrupted time-series method by the departments and diseases to analyze the relationship of EMR application and LOS. Through our analyses, we concluded that, under unadjusted condition, LOS were all reduced (P < 0.001) after EMR application in four departments and for four diseases. After adjustment by gender, age or admission condition, LOS still all decreased after EMR application (P < 0.05) regardless of departments or diseases. The trend changes in LOS reversed from increasing to decreasing in the orthopedics department (coefficient: 0.016 to -0.079), the cardiovascular surgery department (coefficient: 0.007 to -0.126) and all departments overall (coefficient: 0.004 to -0.070), as well as for the intervertebral disc disorders (coefficient: 0.026 to -0.068). Furthermore, the decreasing trend gained a larger slope in the cardiology department (coefficient: -0.017 to -0.023), the neurology department (coefficient: -0.012 to -0.043) and for the coronary heart disease (coefficient: -0.010 to -0.018), the ventricular septal defect (coefficient: -0.024 to -0.059), and the cerebral infarction (coefficient: -0.031 to -0.040). Together, these findings indicate that EMR application coincided with a decrease in LOS and may have a contribution to the decrease.
Collapse
Affiliation(s)
- Peng Yang
- Institute for Health Informatics, Fourth Military Medical University, Xi'an, China,
| | | | | | | | | | | |
Collapse
|
14
|
EHR in emergency rooms: exploring the effect of key information components on main complaints. J Med Syst 2014; 38:36. [PMID: 24687240 DOI: 10.1007/s10916-014-0036-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
This study characterizes the information components associated with improved medical decision-making in the emergency room (ER). We looked at doctors' decisions to use or not to use information available to them on an electronic health record (EHR) and a Health Information Exchange (HIE) network, and tested for associations between their decision and parameters related to healthcare outcomes and processes. Using information components from the EHR and HIE was significantly related to improved quality of healthcare processes. Specifically, it was associated with both a reduction in potentially avoidable admissions as well as a reduction in rapid readmissions. Overall, the three information components; namely, previous encounters, imaging, and lab results emerged as having the strongest relationship with physicians' decisions to admit or discharge. Certain information components, however, presented an association between the diagnosis and the admission decisions (blood pressure was the most strongly associated parameter in cases of chest pain complaints and a previous surgical record for abdominal pain). These findings show that the ability to access patients' medical history and their long term health conditions (via the EHR), including information about medications, diagnoses, recent procedures and laboratory tests is critical to forming an appropriate plan of care and eventually making more accurate admission decisions.
Collapse
|