Abstract
The Dutch hospital population is aging. Geriatric problems are complex due to multi-morbidity, frailty, communication difficulties and polypharmacy. Hospital clinicians should gain more geriatric knowledge to care for older patients. Clinical Decision Support Systems (CDSSs) can support the implementation of geriatric knowledge to all clinicians.
This thesis contributes to development efforts of effective CDSSs in the care of older hospitalized patients. Part 1 of this thesis shows that users and experts prefer CDSSs supporting discharge/aftercare, medication review, fall prevention and delirium care. Therefore, the CDSS development efforts in this thesis focuses on the latter three domains. For falls and delirium, a Functional Resonance Analysis Method (FRAM) study describes differences between work-as-imagined (guidelines) and work-as-done (actual care). Part 2 describes three studies showing that Electronic Health Records (EHR) data give opportunities to assess the quality of clinical knowledge and identify common clinical problems. These studies focus on the domains medication review, identifying potentially inappropriate prescribing, and falls. Part 3 describes validation studies of CDSSs for medication review and a systematic review concluding that CDSSs can improve hospital care for older patients, especially on process-related outcomes. We recommend exploring the use of FRAM, possibilities of EHR data and data-driven CDSSs in future developments of decision support in hospital care for older patients.
This thesis contributes to development efforts of effective CDSSs in the care of older hospitalized patients. Part 1 of this thesis shows that users and experts prefer CDSSs supporting discharge/aftercare, medication review, fall prevention and delirium care. Therefore, the CDSS development efforts in this thesis focuses on the latter three domains. For falls and delirium, a Functional Resonance Analysis Method (FRAM) study describes differences between work-as-imagined (guidelines) and work-as-done (actual care). Part 2 describes three studies showing that Electronic Health Records (EHR) data give opportunities to assess the quality of clinical knowledge and identify common clinical problems. These studies focus on the domains medication review, identifying potentially inappropriate prescribing, and falls. Part 3 describes validation studies of CDSSs for medication review and a systematic review concluding that CDSSs can improve hospital care for older patients, especially on process-related outcomes. We recommend exploring the use of FRAM, possibilities of EHR data and data-driven CDSSs in future developments of decision support in hospital care for older patients.
| Original language | English |
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| Qualification | Doctor of Philosophy |
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| Supervisors/Advisors |
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| Award date | 6 Apr 2022 |
| Print ISBNs | 9789464237146 |
| Publication status | Published - 2022 |
