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| 題 名 | 結核病高風險族群以臨床決策支持系統進行胸部X光檢查之成效=Using Clinical Decision Support System to Facilitate Chest X-ray Screening for Active Tuberculosis among High Risk Patient Groups in a Tertiary Care Hospital in Taiwan |
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| 作 者 | 古家萍; 蕭博徽; 蔡瑱諭; 廖琪玉; 楊雅仁; 盤松青; 王振源; 陳宜君; 高淑芬; | 書刊名 | 感染控制雜誌 |
| 卷 期 | 34:5 2024.10[民113.10] |
| 頁 次 | 頁285-296 |
| 分類號 | 415.277 |
| 關鍵詞 | 結核病高風險族群; 胸部X光檢查; 臨床決策支持系統; High risk groups for active tuberculosis; Chest-X ray; Clinical decision support system; |
| 語 文 | 中文(Chinese) |
| DOI | 10.6526/ICJ.202410_34(5).0001 |
| 中文摘要 | 截至目前為止,結核病仍是危害我國國民健康、降低社會生產力與國際競爭 力的重要傳染病。世界衛生組織也以「終止全球結核病的流行」為努力目標,期 望在 2035 年結核病新案發生率能降至每年每 10 萬人口 10 例。而另一方面,隨 著結核病新發生個案數下降以及病人疾病複雜度高,發病症狀不具特異性,導致 臨床醫師缺乏經驗與警覺心,未能及時診斷結核病,造成延遲治療與傳播風險。 為更積極推動防疫政策,本院組成核心工作小組,透過臨床決策支持系統 (clinical decision support system; CDSS),以使用抗腫瘤壞死因子阻斷劑者、血 糖控制不佳的糖尿病病人、血液透析或腹膜透析病人、愛滋病毒感染者、器官移 植者及 65 歲以上老年人等結核病發病之高風險族群為主要對象,規劃與建立「高 風險族群胸部 X 光提示視窗」,並跨科部邀請相關科室分享門診特色與執行困難 點,藉此凝聚共識,提升執行效能。期望透過臨床決策支持系統強化高風險族群 結核病主動發現策略,及早發現感染源,阻斷傳播鏈,縮短疾病傳播時間。 結果:結核病高風險族群胸部 X 光檢查之主動發現策略的執行成效從 76.6% 上升到 82.0%,不具執行成效則是由 23.4% 降至 18.0%,皆達統計學上顯著差異 (p <.001)。臨床決策支持系統可以協助臨床醫師,偵測符合高風險病人及主動提 供結核病胸部 X 光篩檢服務。 |
| 英文摘要 | Tuberculosis (TB) remains an important communicable disease globally. Considering the death, suffering and diseases caused by TB, WHO proposes in 2014 to “end the global TB epidemic” by 2035. On the other hand, the decreasing incidence of TB and the increased comorbidities of patients lead to the difficulty for the primary care physicians in early diagnosis of active TB, which may delay the treatment and increase the risk of disease transmission. Thus, the TB control team, in a tertiary care hospital in Taiwan, aim to use clinical decision support system (CDSS) to actively screen high risk patient groups for TB (eg: > 65 years-old, HIV, receiving tumor necrosis factor alpha (TNF-α) inhibitors, hemodialysis, solid organ transplantation, poor DM control). We developed the chest X-ray reminding window for high risk TB groups in the outpatient clinic system (OPD) and invite the involved department to clarify the patients identify method and resolve possible hinders. The “chest X-ray reminding window” for high risk TB group started since April 10, 2021 and we compare the performance between lead-in phase (April 10, 2021 to Dec. 31, 2021) and the maintenance phase (Jan. 1, 2022 to Sep 30, 2022). There were total 38,724 events had the pup-up reminding during the OPD visit. The percentage of physicians respond to the reminding window increased from 76.6% in lead-in phase to 82.0% in maintenance phase (p<.001). The CDSS can help in patients fulfill the risk criteria and facilitate the primary care physicians to provide active screening for patients with high risk for active TB. |
本系統中英文摘要資訊取自各篇刊載內容。