Disseminating health evidence summaries to increase evidence use in health care.

OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

Disseminating health evidence summaries to increase evidence use in health care

ABSTRACT OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

Using ontologies to retrieve health evidence information from clinical notes / Uso de ontologias para recuperar informação de evidência em saúde a partir de notas clínicas / El uso de ontologías para recuperar información de evidencia em salud a partir de las notas clínicas

Objective: To present a strategy to search evidence databases directly from clinical notes, thus relieving health professionals from performing searches. Method: An ontology related to health domain, specifically for the domain of adult asthma, was developed to illustrate how to extract search terms from clinical notes. Another ontology was developed to describe evidence databases. Results: Synthetic notes, simulating clinical conditions for patients with respiratory diseases, were used to search information from two evidence databases, PubMed and PEDro. SPARQL queries were automatically generated to connect both ontologies. Conclusion: This scenario demonstrated how to search for evidence from electronic health records notes, helping health professionals to receive relevant information while they assist patients.

Objetivo: Apresentar uma estratégia para pesquisar bases de evidências a partir de notas clínicas, aliviando os profissionais de saúde da tarefa de elaborar buscas. Método: Uma ontologia no domínio da saúde, especificamente sobre asma em adultos, foi desenvolvida para ilustrar como obter informação para a estratégia de busca a partir das notas clínicas. Outra ontologia captura informações sobre as bases de evidências. Resultados: Notas sintéticas, simulando condições clínicas de pacientes com doenças respiratórias, foram utilizadas para buscar informação em duas bases de evidências distintas, PubMed e PEDro. Consultas em SPARQL foram automaticamente geradas para conectar as ontologias. Conclusão: Este cenário demonstrou a viabilidade de procurar por evidências a partir de registros eletrônicos de saúde, ajudando os profissionais de saúde a obter informações relevantes enquanto atendem pacientes.

Objetivo: Presentar una estrategia para buscar bases de evidencia directamente de las notas clínicas, creadas en los registros electrónicos de salud, con ontologías para capturar conocimiento relacionado a la salud y a las bases de evidencia. Método: Una ontología, que se define para el dominio de la salud de asma del adulto, se utiliza para extraer información relevante de notas clínicas. Otra ontología captura información sobre bases de evidencia. Resultados: Notas simulando las condiciones clínicas para pacientes con enfermedades respiratorias se utilizaron para buscar información de dos bases de evidencia, PubMed y Pedro. Consultas SPARQL se generan automáticamente para conectar ambas ontologías. Conclusión: En este escenario se ha demostrado la viabilidad de la búsqueda de evidencia desde los registros electrónicos de salud, ayudando a los profesionales de salud para obtener información relevante al reunirse con pacientes.

Identification of Patient Safety Risks Associated with Electronic Health Records: A Software Quality Perspective.

Although Electronic Health Records (EHR) can offer benefits to the health care process, there is a growing body of evidence that these systems can also incur risks to patient safety when developed or used improperly. This work is a literature review to identify these risks from a software quality perspective. Therefore, the risks were classified based on the ISO/IEC 25010 software quality model. The risks identified were related mainly to the characteristics of "functional suitability" (i.e., software bugs) and "usability" (i.e., interface prone to user error). This work elucidates the fact that EHR quality problems can adversely affect patient safety, resulting in errors such as incorrect patient identification, incorrect calculation of medication dosages, and lack of access to patient data. Therefore, the risks presented here provide the basis for developers and EHR regulating bodies to pay attention to the quality aspects of these systems that can result in patient harm.

Number needed to benefit from information (NNBI): proposal from a mixed methods research study with practicing family physicians.

PURPOSE: We wanted to describe family physicians' use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. METHODS: We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008-2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. RESULTS: In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). CONCLUSION: The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported.

The Clinical Relevance of Information Index (CRII): assessing the relevance of health information to the clinical practice.

BACKGROUND: The high volume of health information creates a need for processes and tools to select, evaluate and disseminate relevant information to health professionals in clinical practice. OBJECTIVES: To introduce an index of the clinical relevance of information and to show that it is different from existing measures. METHODS: A conceptual model of knowledge translation was developed to explain the need for a new index, whose application was verified by an exploratory study with two (quantitative and qualitative) phases. The Clinical Relevance of Information Index (CRII) was defined employing descriptive statistical analyses of assessments performed by health professionals. The model and the CRII were applied in a primary healthcare context. RESULTS: The CRII was applied to 4574 relevance assessments of 194 evidence synopses. The assessments were performed by 41 family physicians in 2008. The CRII value of each synopsis was compared with the number of citations received by its corresponding research paper and with the level of evidence of the study, presenting weak correlation with both. CONCLUSION: The CRII captures aspects of information not considered by other indices. It can be a parameter for information providers, institutions, editors, as well as health and information professionals targeting knowledge translation.