Exploring the Translational Impact of a Home Telemonitoring Intervention Using Time-Motion Study
Exploring the Translational Impact of a Home Telemonitoring Intervention Using Time-Motion Study
复制标题
DOI：
10.1089/tmj.2009.0148
复制
发表时间：
2010-06-01
期刊：
影响因子：
--
通讯作者：
Harrington, Kathleen
中科院分区：
文献类型：
--
作者：
Cady, Rhonda;Finkelstein, Stanley;Harrington, Kathleen
目的：家庭远程监护改善了临床结果，但可能产生大量数据。通过临床决策支持自动化数据监测可以减少将这些系统转化为临床环境的影响。我们利用时间-运动方法来测量两组家庭肺量计远程监测随机对照试验中的活动监测受试者所花费的时间：手动护士审查（对照）组和自动审查（干预）组。对这些结果进行检查，以了解当干预转化为临床环境时可能发生的潜在工作流程影响。材料与方法：时间运动是一种成熟的工业工程技术，用于通过测量预定义的离散任务的时间来评估工作流。数据收集通过直接观察两个研究护士由一个观察员使用重复或快速返回计时方法。所有观察到的任务都使用在早期研究中定义和验证的工作活动列表进行编码。在与次要观察者的2小时会话期间收集可靠性数据。结果：建立了主要观察者的可靠性。在35小时的数据收集，938任务观察的样本进行了记录和编码，使用46个以前定义的和5个新定义的工作活动。两个研究组受试者活动时间的组间比较显示，自动审查组花费在数据审查活动上的时间明显更多。对观察到的51项活动进行重新分类，确定了15项将转化为临床环境的活动，其中5项代表潜在的新活动。结论：在临床环境中实施干预可以增加临床工作流程的工作活动。对从事新临床干预的研究人员进行的时间运动研究提供了一个模板，用于在从研究转换到临床环境之前评估这些干预的工作流程影响。
Objective: Home telemonitoring improves clinical outcomes but can generate large amounts of data. Automating data surveillance with clinical decision support could reduce the impact of translating these systems to clinical settings. We utilized time-motion methodology to measure the time spent on activities monitoring subjects in the two groups of a home spirometry telemonitoring randomized controlled trial: the manual nurse review (control) group and the automated review (intervention) group. These results are examined for potential workflow effects that could occur when the intervention translates to a clinical setting. Materials and Methods: Time motion is an established industrial engineering technique used to evaluate workflow by measuring the time of predefined, discrete tasks. Data were collected via direct observation of two research nurses by a single observer using the repetitive or snap-back timing method. All observed tasks were coded using a list of work activities defined and validated in an earlier study. Reliability data were collected during a 2-h session with a secondary observer. Results: Reliability of the primary observer was established. During 35 h of data collection, a sample of 938 task observations were recorded and coded using 46 previously defined and 5 newly defined work activities. Between-group comparisons of activity time for subjects in the two study groups showed significantly more time spent on data review activities for the automated review group. Reclassification of the 51 observed activities identified 15 activities that would translate to a clinical setting, of which 5 represent potentially new activities. Conclusions: Implementing an intervention into a clinical setting could add work activities to the clinical workflow. Time-motion study of research personnel working with new clinical interventions provides a template for evaluating the workflow impact of these interventions prior to translation from a research to a clinical setting.