Development and description of a decision analysis based decision support tool for stroke prevention in atrial fibrillation
被引:35
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作者:
Thomson, R
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机构:
Med Sch Newcastle Upon Tyne, Dept Epidemiol & Publ Hlth, Sch Hlth Sci, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, EnglandMed Sch Newcastle Upon Tyne, Dept Epidemiol & Publ Hlth, Sch Hlth Sci, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England
Thomson, R
[1
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Robinson, A
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机构:
Med Sch Newcastle Upon Tyne, Dept Epidemiol & Publ Hlth, Sch Hlth Sci, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, EnglandMed Sch Newcastle Upon Tyne, Dept Epidemiol & Publ Hlth, Sch Hlth Sci, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England
Robinson, A
[1
]
Greenaway, J
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机构:
Med Sch Newcastle Upon Tyne, Dept Epidemiol & Publ Hlth, Sch Hlth Sci, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, EnglandMed Sch Newcastle Upon Tyne, Dept Epidemiol & Publ Hlth, Sch Hlth Sci, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England
Greenaway, J
[1
]
Lowe, P
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机构:
Med Sch Newcastle Upon Tyne, Dept Epidemiol & Publ Hlth, Sch Hlth Sci, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, EnglandMed Sch Newcastle Upon Tyne, Dept Epidemiol & Publ Hlth, Sch Hlth Sci, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England
Lowe, P
[1
]
机构:
[1] Med Sch Newcastle Upon Tyne, Dept Epidemiol & Publ Hlth, Sch Hlth Sci, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England
来源:
QUALITY & SAFETY IN HEALTH CARE
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2002年
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11卷
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01期
关键词:
D O I:
10.1136/qhc.11.1.25
中图分类号:
R19 [保健组织与事业(卫生事业管理)];
学科分类号:
摘要:
Background: There is an increasing move towards clinical decision making that engages the patient, which has led to the development and use of decision aids to support better decisions. The treatment of patients in atrial fibrillation (AF) with warfarin to prevent stroke is a decision that is sensitive to patient preferences as shown by a previous decision analysis. Aim: To develop a computerised decision support tool, building upon a previous decision analysis, which would engage individual patient preferences in reaching a shared decision on whether to take warfarin to prevent stroke. Methods: The development process had two main phases: (1) the development phase which employed focus groups and repeated interviews with GPs/practice nurses and patients alongside an iterative development of a computerised tool; (2) the training and testing phase in which GPs and practice nurses underwent training in the use of the tool, including the use of simulated patients. The tool was then used in a feasibility study in a small number of patients with AF to inform the design of a subsequent randomised controlled trial. Results: The prototype tool had three components: (1) derivation of an individual patient's values for relevant health states using a standard gamble; (2) presentation/discussion of a patient's risks of stroke using the Framingham equation and the benefits/risks of warfarin from a systematic literature review; and (3) decision making component incorporating the outcome of a Markov decision analysis model. Older patients could be taken through the decision analysis based computerised tool, and patients and clinicians welcomed information on risks and benefits of treatments. The tool required time and training to use. Patients' decisions in the feasibility phase did not necessarily coincide with the output of the decision analysis model, but decision conflict appeared to be reduced and both patients and GPs were satisfied with the process. Conclusions: It is feasible to develop a decision analysis based computer software package that is acceptable to elderly patients and clinicians, but it requires time and expertise to use. It is most likely that a tool of this type will best be used by a small number of clinicians who have developed experience of its use and can maintain their skills.
机构:
Univ Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Univ Cincinnati, Ctr Clin Effectiveness, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Eckman, Mark H.
Wise, Ruth E.
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机构:
Univ Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Univ Cincinnati, Ctr Clin Effectiveness, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Wise, Ruth E.
Naylor, Katherine
论文数: 0引用数: 0
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机构:
Univ Cincinnati, Dept Architecture & Planning, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Naylor, Katherine
Arduser, Lora
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机构:
Univ Cincinnati, Dept English, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Arduser, Lora
Lip, Gregory Y. H.
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h-index: 0
机构:
Univ Birmingham, Ctr Cardiovasc Sci, Birmingham, W Midlands, EnglandUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Lip, Gregory Y. H.
Kissela, Brett
论文数: 0引用数: 0
h-index: 0
机构:
Univ Cincinnati, Dept Neurol, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Kissela, Brett
Flaherty, Matthew
论文数: 0引用数: 0
h-index: 0
机构:
Univ Cincinnati, Dept Neurol, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Flaherty, Matthew
Kleindorfer, Dawn
论文数: 0引用数: 0
h-index: 0
机构:
Univ Cincinnati, Dept Neurol, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Kleindorfer, Dawn
Khan, Faisal
论文数: 0引用数: 0
h-index: 0
机构:
Univ Cincinnati, Div Cardiol, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Khan, Faisal
Schauer, Daniel P.
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h-index: 0
机构:
Univ Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Univ Cincinnati, Ctr Clin Effectiveness, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Schauer, Daniel P.
Kues, John
论文数: 0引用数: 0
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机构:
Univ Cincinnati, Dept Family & Community Med, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
Kues, John
Costea, Alexandru
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机构:
Univ Cincinnati, Div Cardiol, Cincinnati, OH 45267 USAUniv Cincinnati, Div Gen Internal Med, Cincinnati, OH 45267 USA
机构:
Univ Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Univ Cincinnati, Ctr Med, Inst Study Hlth, Cincinnati, OH USAUniv Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Wess, Mark L.
Schauer, Daniel P.
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h-index: 0
机构:
Univ Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Univ Cincinnati, Ctr Med, Inst Study Hlth, Cincinnati, OH USAUniv Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Schauer, Daniel P.
Johnston, Joseph A.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Eli Lilly & Co, US Outcomes Res, Indianapolis, IN 46285 USAUniv Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Johnston, Joseph A.
Moomaw, Charles J.
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h-index: 0
机构:
Univ Cincinnati, Ctr Med, Dept Neurol, Cincinnati, OH USAUniv Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Moomaw, Charles J.
Brewer, David E.
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h-index: 0
机构:
Univ Cincinnati, Ctr Med, Inst Study Hlth, Cincinnati, OH USAUniv Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Brewer, David E.
Cook, E. Francis
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机构:
Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USAUniv Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Cook, E. Francis
Eckman, Mark H.
论文数: 0引用数: 0
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机构:
Univ Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA
Univ Cincinnati, Ctr Med, Inst Study Hlth, Cincinnati, OH USAUniv Cincinnati, Div Gen Internal Med, Med Ctr, Cincinnati, OH 45267 USA