- Author
-
B.A. Damoiseaux-Volman
- Title
- Decision support in hospital care for older patients
- Subtitle
- Medication, falls and delirium
- Supervisors
- Co-supervisors
-
N. van der Velde
S.K. Medlock - Award date
- 6 April 2022
- Number of pages
- 190
- ISBN
- 9789464237146
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- 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. - Note
- Please note that the acknowledgements section is not included in the thesis downloads.
- Persistent Identifier
- https://hdl.handle.net/11245.1/4a641bb3-470e-467d-b023-89204f0e0927
- Downloads
-
Thesis
Front matter
1: General introduction
2: Priority setting in improving hospital care for older patients using clinical decision support
3: Falls and delirium in older inpatients: Work-as-imagined, work-as-done and preferences for clinical decision support systems
4: Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: A longitudinal study
5: Potentially inappropriate medications and their effect on falls during hospital admission
6: Performance assessment of the John Hopkins fall risk assessment tool in older hospitalized patients
7: Clinical validation of clinical decision support systems for medication review: A scoping review
8: Effect of interventions with a clinical decision support system for hospitalized older patients: Systematic review mapping implementation and design factors
9: Discussion
References; Summary; Samenvatting; List of publications; Author contributions; PhD portfolio; About the author
- Supplementary materials
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