PubMed · 16097128
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Greg Fraser. Problem list coding in e-HIM.. https://pubmed.ncbi.nlm.nih.gov/16097128/
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The positive effect of greater adherence to evidence-based guidelines on possibilities of optimizing diagnosis and therapy has been shown various times. Electronic systems for interactive support and systematization of physicians' decision-making represent a relatively new method for implementing guidelines. Introducing the "schizophrenia module", newly developed decision support software is presented combining electronic data processing-based, quality-oriented documentation and interactive decision support in the outpatient treatment for schizophrenic disorders. Structure, functionality, and options of use are presented. Besides classic measures of quality management (benchmarking), electronic decision support systems can contribute to improve process quality and outcome in the treatment of mental diseases.
In-house audit demonstrated that 49% (173/352) of patients attending routine HIV outpatient care are asymptomatic and have needs that could potentially be met by other health care professionals. We therefore evaluated the potential development and acceptability of nurse practitioner roles in contributing to HIV outpatient care. Data were collected through 26 consultation observations, 25 patient interviews, 2 patient focus groups, 22 provider interviews and 8 provider focus groups. Service users were key members of the evaluation team. With increasing HIV incidence and the change in focus of doctor-patient consultations from acute to chronic disease management, there are concerns about the sustainability of easily available routine HIV outpatient appointments using the same model of care that has prevailed over the past 20 years. Nurse practitioner models of care were considered acceptable for asymptomatic patients, including those who do not have complex issues related to highly active antiretroviral therapy (HAART). Key considerations for the role include training, supervision, referral pathways, and a clear understanding of the limitations of nursing practice. There is an emphasis on the need to consider 'new ways of working' throughout the service, rather than merely substituting or transferring clinical roles between professionals. Funding pending, nurse practitioner roles are planned for implementation in late 2004. Evaluation will determine impact on service utilization, health and economic outcomes.
BACKGROUND: The One Minute Preceptor (OMP) faculty development workshop is aimed at improving outpatient preceptors' abilities to teach in ambulatory settings. Practice applying the 5 microskills is central to learning the OMP, yet participants frequently avoid the role-playing portion of the standard workshop. Task complexity may result in significant cognitive burden while learning these new teaching skills. DESCRIPTION: The development of highly scripted case scenarios and standardized learners (SLs) to role-play authentic teaching situations are aimed at reducing task complexity. We describe case development, SL training, and application of these enhancements in 5 OMP workshops. EVALUATION: Qualitative assessments and workshop participant evaluations showed improved role-playing participation and satisfaction with the authenticity of the training sessions. CONCLUSION: The introduction of highly scripted cases and SLs appear to effectively help participants overcome dissatisfaction with role-playing and provide increasingly challenging yet authentic clinical teaching scenarios for skills practice. We recommend further research using objective measures.