What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation.
What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation.
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DOI：
10.1186/s13012-017-0644-2
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发表时间：
2017-09-15
期刊：
影响因子：
--
通讯作者：
Moja L
中科院分区：
文献类型：
--
作者：
Liberati EG;Ruggiero F;Galuppo L;Gorli M;González-Lorenzo M;Maraldi M;Ruggieri P;Polo Friz H;Scaratti G;Kwag KH;Vespignani R;Moja L
先进的计算机化决策支持系统（CDSS）协助临床医生在他们的决策过程中，根据最新的科学证据产生建议。虽然这项技术有可能提高病人护理的质量，但仅仅提供并不能保证被采用：即使在有CDSS的地方，临床医生也往往没有采纳他们的建议。本研究探讨的障碍和促进剂，以吸收的循证CDSS所感知的不同的卫生专业人员在医院的CDSS采用的不同阶段。作为CDSS系列随机对照试验的一部分进行的定性研究。样本包括两家使用CDSS的医院和两家计划在未来采用CDSS的医院。我们采访了医生、护士、信息技术人员和董事会成员（n = 30）。我们采用了持续的比较方法来制定指导实施的框架。我们确定了六组的经验，对CDSS的态度，我们标签为“立场”。这六个位置代表了对CDSS控制的获取梯度（从低到高），其特征在于对CDSS摄取的不同类型的屏障。最严重的障碍（在第一种立场中普遍存在）包括临床医生认为CDSS可能会减少他们的专业自主权，或者在医疗法律争议的情况下可能会被用来对付他们。向最后一个位置移动，这些障碍被与技术接口相关的技术和可用性问题所取代。当所有的障碍都被克服，CDSS被视为一个工作工具，在其用户的服务，整合临床医生的推理和促进组织学习。使用CDSS的障碍和促进因素是动态的，可能在临床环境中引入之前就存在;提供一个静态的障碍和促进因素列表，无论具体的实施阶段和背景如何，可能不足以或不利于促进吸收。在探讨医院是否准备采用CDSS时，需要考虑临床医生对科学证据和指南的态度、跨学科关系的质量以及透明度和问责制的组织精神等因素。本文的在线版本（10.1186/s13012-017-0644-2）包含补充材料，可供授权用户使用。
Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation. We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as “positions.” The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning. Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs. The online version of this article (10.1186/s13012-017-0644-2) contains supplementary material, which is available to authorized users.
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