Email recruitment to use web decision support tools for XXXX .

@entity1 @entity497 @entity55
Application of guidelines to improve clinical decisions for @entity497 ( @entity497 ) @entity1 depends on accurate information about specific facts of each case and on presenting guideline support at the time decisions are being made. We report here on a system designed to solicit information from physicians about their @entity497 @entity1 in order to classify @entity497 and present appropriate guidelines for type of care, length of stay, and use of antibiotics. We used elements of three existing information systems to create a achieve these goals: professionals coding diagnoses captured by the existing clinical information system (CIS), email, and web-based decision support tools including a @entity55 severity evaluation tool (SET). The non-secure IS components (email and web) were able to link to information in the CIS using tokens that do not reveal confidential @entity1 -identifiable information. We examined their response to this strategy and the accuracy of @entity55 classification using this approach compared to chart review as a gold standard. On average physicians responded to email solicitations 50% of the time over the 14 month study. Also using this standard, we examined various information triggers for case finding. Professional coding of the primary reason for admission as @entity55 was fairly sensitive as an indicator of @entity497 . Physician use of the web SET was insensitive but fairly specific. Pneumonia classification using the SET was very reliable compared to experts' chart review using the same algorithm. We examined the distribution of severity of @entity55 for cases of @entity55 found by the various information triggers and for each severity the average length of stay. The distribution found by both chart review and by SET has demonstrated a shift toward more severe cases being admitted compared to only 3 years ago. The length of stay for level of severity is above expectations published by guidelines even for cases of true @entity497 by chart review. We suggest that the Fine classification system may not adequately describe @entity1 in this setting. Physicians frequently responded that the guidelines presented did not fit their @entity1 .
