Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research
Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research
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DOI：
10.1016/j.ijmedinf.2015.09.005
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发表时间：
2015-12-01
影响因子：
4.9
通讯作者：
Montella, Diane
中科院分区：
文献类型：
--
作者：
Miller, Anne;Moon, Brian;Montella, Diane
目的：计算机化的临床决策支持系统（CDSS）是一种新兴的手段，以提高医疗保健的安全性，质量和效率，但荟萃分析的结果是混合的。纳入标准：纳入2000年至2013年以英文发表的涉及医生、注册护士和高级执业护士在临床实践中使用CDSS的经验的定性研究。检索策略：检索PubMed和CINAHL数据库。根据入选标准筛选研究标题和摘要。根据质量标准对保留的研究进行评价。结果是从质量分数的第四个四分位数的研究中迭代提取的。两个评论家归纳地构建了主题。第三个审查应用定义的主题演绎实现92%agreement.Results：3798独特的记录返回，56符合纳入标准，并对质量标准进行了审查。9项研究的质量足以进行综合分析。五大主题（临床医生，患者系统集成;用户界面的可用性;需要更好的“算法”;系统的成熟度;患者的安全性）被defined.Conclusions：尽管不断发展，CDSS仍然是一个新兴的技术。对人类决策者和CDSS之间的交互缺乏理解和考虑是系统采用和使用不佳的主要原因。需要进一步的高质量定性研究，以更好地了解人与系统的相互作用问题。如果不解决这些问题，可能会继续混淆定量研究结果。(C)由Elsevier爱尔兰有限公司出版。
Purpose: Computerized clinical decision support systems (CDSS) are an emerging means for improving healthcare safety, quality and efficiency, but meta-analyses findings are mixed. This meta-synthesis aggregates qualitative research findings as possible explanations for variable quantitative research outcomes.Inclusion criteria: Qualitative studies published between 2000 and 2013 in English, involving physicians, registered and advanced practice nurses' experience of CDSS use in clinical practice were included. Search strategy: PubMed and CINAHL databases were searched. Study titles and abstracts were screened against inclusion criteria. Retained studies were appraised against quality criteria. Findings were extracted iteratively from studies in the 4th quartile of quality scores. Two reviewers constructed themes inductively. A third reviewer applied the defined themes deductively achieving 92% agreement.Results: 3798 unique records were returned; 56 met inclusion criteria and were reviewed against quality criteria. 9 studies were of sufficiently high quality for synthetic analysis. Five major themes (clinician-patient-system integration; user interface usability; the need for better 'algorithms'; system maturity; patient safety) were defined.Conclusions: Despite ongoing development, CDSS remains an emerging technology. Lack of understanding about and lack of consideration for the interaction between human decision makers and CDSS is a major reason for poor system adoption and use. Further high-quality qualitative research is needed to better understand human-system interaction issues. These issues may continue to confound quantitative study results if not addressed. (C) 2015 Published by Elsevier Ireland Ltd.