RESUMEN
PURPOSE: We implemented computer-based reminders for CD4 count tests at an HIV clinic in Western Kenya though an open-source Electronic Medical Record System. Within a month, providers had stopped complying with the reminders. METHODS: We used a multi-method qualitative approach to determine reasons for failure to adhere to the reminders, and took multiple corrective actions to remedy the situation. RESULTS: Major reasons for failure of the reminder system included: not considering delayed data entry and pending test results; relying on wrong data inadvertently entered into the system; inadequate training of providers who would sometimes disagree with the reminder suggestions; and resource issues making generation of reminders unreliable. With appropriate corrective actions, the reminder system has now been functional for over eight months. CONCLUSION: Implementing clinical decision support in resource-limited settings is challenging. Understanding and correcting root causes of problems related to reminders will facilitate successful implementation of the decision support systems in these settings.
Asunto(s)
Instituciones de Atención Ambulatoria , Sistemas de Apoyo a Decisiones Clínicas , Infecciones por VIH , Sistemas Recordatorios , Recuento de Linfocito CD4 , Continuidad de la Atención al Paciente , Estudios de Evaluación como Asunto , Humanos , KeniaRESUMEN
Being able to better understand the effects of emergency department overcrowding can improve patient outcome. We propose to evaluate various predictors of mortality based on our ability to identify at what point an ED becomes too busy causing decreased quality of care. The study aims to utilize information from hospital records and statewide death records to find significant increases in mortality associated with presenting to the ED during a busy period of time.