An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia.
An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia.
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DOI：
10.3390/jpm10030067
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发表时间：
2020-07-23
影响因子：
--
通讯作者：
Kullo IJ
中科院分区：
文献类型：
--
作者：
Bangash H;Pencille L;Gundelach JH;Makkawy A;Sutton J;Makkawy L;Dikilitas O;Kopecky S;Freimuth R;Caraballo PJ;Kullo IJ
基于电子健康记录（EHR）的临床决策支持（CDS）可以解决家族性高胆固醇血症（FH）的低认识和治疗不足问题，FH是一种与冠心病风险显著增加相关的疾病。我们的目标是将供应商的观点纳入到FH CDS工具的开发和实施中。一个实现科学的框架和以用户为中心的设计过程被用来创建一个CDS工具FH。初级保健医生和专科医生参加了定性访谈，可用性测试和实施调查。CDS配置为两种格式-最佳实践警报（BPA）和收文篮消息，随后以静默模式部署在EHR中。访谈记录分析的关键主题包括对FH的理解和认识、临床工作流程、医生偏好和CDS工具的价值、对患者需求和价值的看法以及传播和实施。与可用性相关的建议包括首选CDS格式和位置、内容、时间和频率以及警报紧急程度/优先级。84.6%的医生认为CDS可以改善FH的早期诊断，92.3%的医生认为CDS可以帮助他们识别和管理FH患者。医生反馈导致CDS迭代细化。总之，我们使用实施科学框架和医生反馈开发了FH的CDS工具。初步部署显示FH的负担很大，CDS工具可能会产生很大影响。
Electronic health record (EHR)-based clinical decision support (CDS) can address the low awareness and undertreatment of familial hypercholesterolemia (FH), a disorder associated with a markedly increased risk of coronary heart disease. We aimed to incorporate provider perspectives into the development and implementation of a CDS tool for FH. An implementation science framework and a user-centered design process were used to create a CDS tool for FH. Primary care physicians and specialist physicians participated in qualitative interviews, usability testing and an implementation survey. The CDS was configured in two formats—a best practice alert (BPA) and an in-basket message and subsequently deployed in the EHR in silent mode. The key themes that emerged from the analysis of interview transcripts included understanding and awareness of FH, clinical workflow, physician preferences and value of CDS tools, perspectives on patient needs and values and dissemination and implementation. Recommendations related to usability included preferred CDS format and placement, content, timing and frequency, and level of alert urgency/prioritization. In response to the survey, 84.6% of physicians agreed that the CDS would improve early FH diagnosis and 92.3% agreed that it would help them identify and manage FH patients. Physician feedback led to iterative CDS refinement. In summary, we developed a CDS tool for FH using an implementation science framework and physician feedback. Initial deployment revealed a significant burden of FH and the potential for the CDS tool to have a large impact.
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影响因子：
4.4
作者：
Arndt, Brian G.;Beasley, John W.;Gilchrist, Valerie J.
通讯作者：
Gilchrist, Valerie J.
影响因子：
12.7
作者：
Glasgow, Russell E.;Vinson, Cynthia;Hunter, Christine
通讯作者：
Hunter, Christine
影响因子：
7.4
作者：
Lee, Christopher;Rivera-Valerio, Miriannie;Kullo, Iftikhar J.
通讯作者：
Kullo, Iftikhar J.
影响因子：
3.5
作者：
Ancker JS;Edwards A;Nosal S;Hauser D;Mauer E;Kaushal R;with the HITEC Investigators
通讯作者：
with the HITEC Investigators
影响因子：
3.5
作者：
Elwyn G;Scholl I;Tietbohl C;Mann M;Edwards AG;Clay C;Légaré F;van der Weijden T;Lewis CL;Wexler RM;Frosch DL
通讯作者：
Frosch DL