Biomedical subjects

Rianne Bindels

Publications and source records attributed to Rianne Bindels.

5 recordsLinked to original sources

PubMed2006

Developing an integrated electronic nursing record based on standards.

The Radboud University Nijmegen Medical Centre in the Netherlands develops a multidisciplinar (Electronic Health Record) based on the latest HL7 v3 (Health Level 7 version 3) D-MIM : Care provision. As part of this process we are trying to establish which nursing diagnoses and activities are minimally required. These NMDS (Nursing Minimal Data Set) are mapped or translated to ICF (for diagnoses) and CEN1828 Structures for (for activities). The mappings will be the foundation for the development of user interfaces for the registration of nursing activities. A homegrown custom-made web based configuration tool is used to exploit the possibilities of HL7 v3. This enables a sparkling launch of user interfaces that can contain the diversity of health care work processes. The first screens will be developed to support history taking for the nursing chart of the Neurology ward. The screens will contain both Dutch NMDS items and ward specific information. This will be configured dynamically per (group of) ward(s).

Medical Records Systems, Computerized↗

PubMed2004

Evaluation of an automated test ordering and feedback system for general practitioners in daily practice.

OBJECTIVE: To evaluate the use of an automated test ordering and feedback system (named GRIF) in daily practice. The system produces recommendations to general practitioners (GPs) to improve the application of accepted practice guidelines for test ordering. METHODS: A randomised controlled trial with balanced block design was carried out in general practices in two regions of the Netherlands from August 2000 to July 2001. We implemented the GRIF system on the workstations at the offices of the participating GPs. The GPs (n=11) were asked to use GRIF during patient consultation instead of filling in the paper request form. The system displayed critical comments about their non-adherence to the guidelines as apparent from the request forms. RESULTS: The median time of producing the comments plus the response time of the GP was 13s. Of the 2780 presented recommendations, 4.3% were accepted. Advice of the GRIF system that presents a concrete test to request in a particular situation is adhered to most frequently. Finally, there seems to be a decrease of accepted comments over the trial period. CONCLUSION: Computerised recommendations should contain, if possible, suggestions for alternative tests to improve the application of these recommendations. Furthermore, creative solutions must be developed to avoid that GPs get used to the recommendations of critiquing systems and to stimulate a better adherence to these recommendations.

Adult↗

PubMed2003

User satisfaction with a real-time automated feedback system for general practitioners: a quantitative and qualitative study.

OBJECTIVE: The GRIF automated feedback system produces real-time comments on the appropriateness of diagnostic tests ordered by general practitioners (GPs) based on recommendations from accepted national and regional practice guidelines. We investigated the experiences of GPs with this system and, more specifically, with the recommendations produced by the system as well as their views on using this system in daily practice. SETTING: We tested the GRIF system in an experiment in a laboratory setting and in a daily practice trial. STUDY PARTICIPANTS: General practitioners. INTERVENTION: In the laboratory experiment, GPs used the GRIF system to assess the appropriateness of 30 request forms. Each of the GPs was confronted with requests they had submitted to the diagnostic unit of the hospital in the past. In the field trial, the GRIF system was applied during patient consultations for 1 year. MAIN OUTCOME MEASURES: We measured GPs' satisfaction with the system using a questionnaire, and also conducted group discussions (in the laboratory experiment) and in-depth interviews (in the field trial) to elicit GPs' opinions of and experiences with the system. In addition, we explored GPs' reasons for not accepting the comments offered by the GRIF system. RESULTS: The results show that the GPs in the laboratory experiment had more positive attitudes towards the system compared with participants in the field trial. All discussion groups and most of the GPs in the field trial regarded receiving the immediate feedback during the test ordering process as an important advantage. The most frequently mentioned reason to reject the recommendation was disagreement with the content and/or the recommendations in the practice guidelines. CONCLUSION: Apart from securing agreement on guideline content, a prerequisite for using GRIF in daily practice on a large scale is that more attention is paid to promotion of the guidelines and their adoption, and stimulation of a positive attitude towards the practice guidelines among the users.

Attitude of Health Personnel↗

PubMed2003

The efficacy of an automated feedback system for general practitioners.

OBJECTIVE: An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs. DESIGN: We used a randomised controlled trial with balanced block design. SETTING: Five times six participant groups of GPs in a computer laboratory setting. INTERVENTION: The GPs reviewed a random sample of 30 request forms they filled in earlier that year. If deemed necessary, they could make changes in the tests requested. Next, the system displayed critical comments about their non-adherence to the guidelines as apparent from the (updated) request forms. SUBJECTS: Twenty-four randomly selected GPs participated. MAIN OUTCOME MEASURES: The number of requested diagnostic tests (17% with 95% confidence interval [CI]: 12-22%) and the fraction of tests ordered that were not in accordance with the practice guidelines (39% with 95% CI: 28-51%) decreased due to the comments of the automated feedback system. The GPs accepted 362 (50%) of the 729 reminders. IMPLICATIONS: Although our experiment cannot predict the size of the actual effect of the automated feedback system in daily practice, the observed effect may be seen as the maximum achievable.

Decision Support Systems, Clinical↗

PubMedDate not supplied

The reliability of assessing the appropriateness of requested diagnostic tests.

Despite a poor reliability, peer assessment is the traditional method to assess the appropriateness of health care activities. This article describes the reliability of the human assessment of the appropriateness of diagnostic tests requests. The authors used a random selection of 1217 tests from 253 request forms submitted by general practitioners in the Maastricht region of The Netherlands. Three reviewers independently assessed the appropriateness of each requested test. Interrater kappa values ranged from 0.33 to 0.42, and kappa values of intrarater agreement ranged from 0.48 to 0.68. The joint reliability coefficient of the 3 reviewers was 0.66. This reliability is sufficient to review test ordering over a series of cases but is not sufficient to make case-by-case assessments. Sixteen reviewers are needed to obtain a joint reliability of 0.95. The authors conclude that there is substantial variation in assessment concerning what is an appropriately requested diagnostic test and that this feedback method is not reliable enough to make a case-by-case assessment. Computer support maybe beneficial to support and make the process of peer review more uniform.

Decision Support Systems, Clinical↗