Clinical Benefits of an Embedded Decision Support System in Anticoagulant Control
Computer-based decision support (CDSS) systems can
deliver real patient care and increase chances of long-term survival in
areas of chronic disease management prone to poor control. One such
CDSS, for the management of warfarin, is described in this paper and
the outcomes shown. Data is derived from the running system and
show a performance consistently around 20% better than the
applicable guidelines.
[1] J.R. Mohr, "A Quantitative Perspective on the Virtual Patient Record
(VPR) and its realization." Medinfo 9(1): 21-25. 1998.
[2] K. Kawamoto, C.A. Houlihan, E.A. Balas, and D.F. Lobach. "Improving
clinical practice using clinical decision support systems: a systematic
review of trials to identify features critical to success". BMJ April 2005;
330: 765
[3] S. Turner, S. Iliffe, M. Downs, M. Bryans, J. Wilcock and T. Austin,
"Decision support software for dementia diagnosis and management in
primary care: relevance and potential". 2001 Annual Conference of the
European Health Management Association, Granada, Spain, June 2001
[4] B.D. Vadher, D.L.H. Patterson and M. Leaning, "Comparison of Oral
Anticoagulant Control by a Nurse-Practitioner Using a Computer
Decision-Support System With That by Clinicians." Clinical Laboratory
Haematology 19:203-207.
[5] B. Vadher, D.L.H. Patterson and M. Leaning, "Evaluation of a decision
support system for initiation and control of oral anticoagulation in a
randomised trial" BMJ 1997;314:1252
[6] B.D. Vadher, D.L.H. Patterson and M.S. Leaning, "Validation of an
algorithm for oral anticoagulant dosing and appointment scheduling."
Clinical Laboratory Haematology 17:339-345. 1995.
[7] B.D. Vadher, "Development and Evaluation of a decision-aid for
warfarin dosing and monitoring during initiation and maintenance
therapy." M.D. Thesis. 1998
[8] H.L. Chin and P. Wallace, "Embedding guidelines into direct physician
order entry: Simple methods, powerful results." Proceedings of the
American Medical Informatics Association Annual Symposium: 221-5.
1999.
[9] D.W. Bates, J.M. Teich, J. Lee, D. Seger, G.J. Kuperman, N. Ma'Luf, D.
Boyle and L. Leape, "The impact of computerized physician order entry
on medication error prevention." Journal of the American Medical
Informatics Association 6(4): 313-21. 1999.
[10] G.J. Kuperman, J.M. Teich, M.J. Tanasijevic, N. Ma'Luf, E. Rittenberg,
A Jha, J. Fiskio, J. Winkelman and D.W. Bates, "Improving response to
critical laboratory results with automation: Results of a randomized
controlled trial." Journal of the American Medical Informatics
Association 6(6): 512-22. 1999
[11] D.M. Rind, R. Davis and C. Safran, "Designing studies of computerbased
alerts and reminders." MD Computing 12(2): 122-6. 1995.
[12] G. Chatellier, I. Colombet and P. Degoulet, "Computer-adjusted dosage
of anticoagulant therapy improves the quality of anticoagulation."
Medinfo 9(2): 819-823. 1998.
[13] G. Chatellier, I. Colombet and P. Degoulet, "An overview of the effect
of computer assisted management of anticoagulant therapy on the
quality of anticoagulation." International Journal of Medical Informatics
49(3): 311-20. 1998.
[14] D. Kalra, D.L.H. Patterson, T. Austin, D. Ingram, D. Lloyd, J. Milan, J.
Grimson and W Grimson, "Synapses In Use: Supporting Cardiac Care at
the Whittington Hospital." Proceedings of Toward An Electronic Health
Record Europe '98. 306-312. 1998.
[15] T. Austin, S. Iliffe, M.S. Leaning and M. Modell, "A Prototype
Computer Decision Support System for the Management of Asthma."
Journal of Medical Systems 20(1):45-55. 1996.
[16] G. Lanzola. and M. Stefanelli, "A specialised framework for medical
diagnostic knowledge-based systems." Computers and Biomedical
Research 25:351-365. 1992.
[17] C.P. Friedman and J.C. Wyatt, "Evaluation Methods in Medical
Informatics." Springer. ISBN: 0-387-94228-9. 2000.
[18] T. Austin, "The Development and Comparative Evaluation of
Middleware and Database Architectures for the Implementation of an
Electronic Healthcare Record." PhD Thesis. 2004.
[19] British Committee for Standards In Haematology. Guidelines on oral
anticoagulation: Third Edition. British Journal of
Haematology.1998;101:374-387.
[20] A. Davies, M.J. Buxton, D.L.H. Patterson and J. Webster-King, "Anticoagulant
Monitoring Service Delivery: A Comparison of Costs of
Hospital and Community Outreach Clinics." Clinical Laboratory
Haematology 22:33-40. 2000.
[1] J.R. Mohr, "A Quantitative Perspective on the Virtual Patient Record
(VPR) and its realization." Medinfo 9(1): 21-25. 1998.
[2] K. Kawamoto, C.A. Houlihan, E.A. Balas, and D.F. Lobach. "Improving
clinical practice using clinical decision support systems: a systematic
review of trials to identify features critical to success". BMJ April 2005;
330: 765
[3] S. Turner, S. Iliffe, M. Downs, M. Bryans, J. Wilcock and T. Austin,
"Decision support software for dementia diagnosis and management in
primary care: relevance and potential". 2001 Annual Conference of the
European Health Management Association, Granada, Spain, June 2001
[4] B.D. Vadher, D.L.H. Patterson and M. Leaning, "Comparison of Oral
Anticoagulant Control by a Nurse-Practitioner Using a Computer
Decision-Support System With That by Clinicians." Clinical Laboratory
Haematology 19:203-207.
[5] B. Vadher, D.L.H. Patterson and M. Leaning, "Evaluation of a decision
support system for initiation and control of oral anticoagulation in a
randomised trial" BMJ 1997;314:1252
[6] B.D. Vadher, D.L.H. Patterson and M.S. Leaning, "Validation of an
algorithm for oral anticoagulant dosing and appointment scheduling."
Clinical Laboratory Haematology 17:339-345. 1995.
[7] B.D. Vadher, "Development and Evaluation of a decision-aid for
warfarin dosing and monitoring during initiation and maintenance
therapy." M.D. Thesis. 1998
[8] H.L. Chin and P. Wallace, "Embedding guidelines into direct physician
order entry: Simple methods, powerful results." Proceedings of the
American Medical Informatics Association Annual Symposium: 221-5.
1999.
[9] D.W. Bates, J.M. Teich, J. Lee, D. Seger, G.J. Kuperman, N. Ma'Luf, D.
Boyle and L. Leape, "The impact of computerized physician order entry
on medication error prevention." Journal of the American Medical
Informatics Association 6(4): 313-21. 1999.
[10] G.J. Kuperman, J.M. Teich, M.J. Tanasijevic, N. Ma'Luf, E. Rittenberg,
A Jha, J. Fiskio, J. Winkelman and D.W. Bates, "Improving response to
critical laboratory results with automation: Results of a randomized
controlled trial." Journal of the American Medical Informatics
Association 6(6): 512-22. 1999
[11] D.M. Rind, R. Davis and C. Safran, "Designing studies of computerbased
alerts and reminders." MD Computing 12(2): 122-6. 1995.
[12] G. Chatellier, I. Colombet and P. Degoulet, "Computer-adjusted dosage
of anticoagulant therapy improves the quality of anticoagulation."
Medinfo 9(2): 819-823. 1998.
[13] G. Chatellier, I. Colombet and P. Degoulet, "An overview of the effect
of computer assisted management of anticoagulant therapy on the
quality of anticoagulation." International Journal of Medical Informatics
49(3): 311-20. 1998.
[14] D. Kalra, D.L.H. Patterson, T. Austin, D. Ingram, D. Lloyd, J. Milan, J.
Grimson and W Grimson, "Synapses In Use: Supporting Cardiac Care at
the Whittington Hospital." Proceedings of Toward An Electronic Health
Record Europe '98. 306-312. 1998.
[15] T. Austin, S. Iliffe, M.S. Leaning and M. Modell, "A Prototype
Computer Decision Support System for the Management of Asthma."
Journal of Medical Systems 20(1):45-55. 1996.
[16] G. Lanzola. and M. Stefanelli, "A specialised framework for medical
diagnostic knowledge-based systems." Computers and Biomedical
Research 25:351-365. 1992.
[17] C.P. Friedman and J.C. Wyatt, "Evaluation Methods in Medical
Informatics." Springer. ISBN: 0-387-94228-9. 2000.
[18] T. Austin, "The Development and Comparative Evaluation of
Middleware and Database Architectures for the Implementation of an
Electronic Healthcare Record." PhD Thesis. 2004.
[19] British Committee for Standards In Haematology. Guidelines on oral
anticoagulation: Third Edition. British Journal of
Haematology.1998;101:374-387.
[20] A. Davies, M.J. Buxton, D.L.H. Patterson and J. Webster-King, "Anticoagulant
Monitoring Service Delivery: A Comparison of Costs of
Hospital and Community Outreach Clinics." Clinical Laboratory
Haematology 22:33-40. 2000.
@article{"International Journal of Information, Control and Computer Sciences:50527", author = "Tony Austin and Shanghua Sun and Nathan Lea and Steve Iliffe and Dipak Kalra and David Ingram and David Patterson", title = "Clinical Benefits of an Embedded Decision Support System in Anticoagulant Control", abstract = "Computer-based decision support (CDSS) systems can
deliver real patient care and increase chances of long-term survival in
areas of chronic disease management prone to poor control. One such
CDSS, for the management of warfarin, is described in this paper and
the outcomes shown. Data is derived from the running system and
show a performance consistently around 20% better than the
applicable guidelines.", keywords = ""Decision Support", "Anticoagulant Control"", volume = "3", number = "5", pages = "1266-7", }
