Barriers and enablers to implementing and using clinical decision support systems for chronic diseases: a qualitative systematic review and meta-aggregation.
Barriers and enablers to implementing and using clinical decision support systems for chronic diseases: a qualitative systematic review and meta-aggregation.
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DOI：
10.1186/s43058-022-00326-x
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发表时间：
2022-07-28
影响因子：
--
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中科院分区：
文献类型：
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临床决策支持 (CDS) 越来越多地用于促进慢性病护理。尽管电子健康记录的可用性不断提高，并且新的 CDS 技术不断发展，但 CDS 在常规临床环境中的应用并不一致。本定性系统评价旨在综合医疗保健提供者的 CDS 经验，探索实施、使用、评估和维持慢性病 CDS 系统的障碍和推动因素。 2011 年至 2021 年在 Medline、CINAHL、APA PsychInfo、EconLit 和 Web of Science 中进行了检索。如果针对医疗保健提供者并研究了相关的慢性病 CDS 干预措施，则纳入了包含定性研究结果的初步研究。相关的 CDS 干预措施以电子健康记录为基础，针对以下一种或多种慢性疾病：心血管疾病、糖尿病、慢性肾病、高血压和高胆固醇血症。使用元聚合方法综合定性研究结果。本次定性系统综述中纳入了 33 篇主要研究文章。定性数据的元聚合揭示了 177 个结果和 29 个类别，这些结果被聚合为 8 个综合结果。综合发现与影响 CDS 吸收的临床背景、用户、外部背景和技术因素有关。采用的主要障碍包括 CDS 系统过于简单、在多发病方面的临床适用性有限，并且与现有工作流程的集成度较差。 CDS 干预措施成功的推动因素包括在提供相关临床知识和结构化慢性病护理方面的感知有用性；通过培训和培训后跟进获得的用户信心；外部环境包括强大的临床冠军、分配的人员和技术支持； CDS 技术功能功能强大且极具吸引力。本次系统综述探讨了医疗保健提供者的经验，重点关注 CDS 用于慢性病的障碍和推动因素。结果为设计、实施和维持未来 CDS 系统提供了证据基础。根据本次审查的结果，我们强调了实践和未来研究的可行步骤。 PROSPERO CRD42020203716 在线版本包含可在 10.1186/s43058-022-00326-x 获取的补充材料。
Clinical decision support (CDS) is increasingly used to facilitate chronic disease care. Despite increased availability of electronic health records and the ongoing development of new CDS technologies, uptake of CDS into routine clinical settings is inconsistent. This qualitative systematic review seeks to synthesise healthcare provider experiences of CDS—exploring the barriers and enablers to implementing, using, evaluating, and sustaining chronic disease CDS systems. A search was conducted in Medline, CINAHL, APA PsychInfo, EconLit, and Web of Science from 2011 to 2021. Primary research studies incorporating qualitative findings were included if they targeted healthcare providers and studied a relevant chronic disease CDS intervention. Relevant CDS interventions were electronic health record-based and addressed one or more of the following chronic diseases: cardiovascular disease, diabetes, chronic kidney disease, hypertension, and hypercholesterolaemia. Qualitative findings were synthesised using a meta-aggregative approach. Thirty-three primary research articles were included in this qualitative systematic review. Meta-aggregation of qualitative data revealed 177 findings and 29 categories, which were aggregated into 8 synthesised findings. The synthesised findings related to clinical context, user, external context, and technical factors affecting CDS uptake. Key barriers to uptake included CDS systems that were simplistic, had limited clinical applicability in multimorbidity, and integrated poorly into existing workflows. Enablers to successful CDS interventions included perceived usefulness in providing relevant clinical knowledge and structured chronic disease care; user confidence gained through training and post training follow-up; external contexts comprised of strong clinical champions, allocated personnel, and technical support; and CDS technical features that are both highly functional, and attractive. This systematic review explored healthcare provider experiences, focussing on barriers and enablers to CDS use for chronic diseases. The results provide an evidence-base for designing, implementing, and sustaining future CDS systems. Based on the findings from this review, we highlight actionable steps for practice and future research. PROSPERO CRD42020203716 The online version contains supplementary material available at 10.1186/s43058-022-00326-x.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1093/jamia/ocx159
发表时间：
2018-05-01
影响因子：
6.4
作者：
Dagliati, Arianna;Sacchi, Lucia;Bellazzi, Riccardo
通讯作者：
Bellazzi, Riccardo
影响因子：
7.2
作者：
Gold, Rachel;Bunce, Arwen;Bulkley, Joanna
通讯作者：
Bulkley, Joanna
影响因子：
3.5
作者：
Fico, Giuseppe;Hernanzez, Liss;Teresa Arredondo, Maria
通讯作者：
Teresa Arredondo, Maria
影响因子：
3.2
作者：
Dixon BE;Alzeer AH;Phillips EO;Marrero DG
通讯作者：
Marrero DG