Usability testing of Avoiding Diabetes Thru Action Plan Targeting (ADAPT) decision support for integrating care-based counseling of pre-diabetes in an electronic health record.
Usability testing of Avoiding Diabetes Thru Action Plan Targeting (ADAPT) decision support for integrating care-based counseling of pre-diabetes in an electronic health record.
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DOI：
10.1016/j.ijmedinf.2014.05.002
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发表时间：
2014-09
影响因子：
4.9
通讯作者：
Mann DM
中科院分区：
文献类型：
--
作者：
Chrimes D;Kitos NR;Kushniruk A;Mann DM
可用性测试可用于评估人机交互（HCI）和共享决策（SDM）中患者-提供者行为改变和行为契约的沟通。传统的可用性评估使用脚本化或模拟患者场景，并结合有声思考协议分析，提供了一种识别HCI问题的方法。在本文中，我们描述了这些方法在通过行动计划目标避免糖尿病（ADAPT）工具评估中的应用，并测试了该工具支持适应框架对糖尿病前期综合护理咨询的可用性。“有声思维”协议分析通常不提供对“实时”临床工作流程中医患互动如何影响的评估，也不提供工具是否成功的评估。因此，采用应用模拟方法的“近现场”临床模拟来补充有声思考的结果。这种互补的可用性技术被用于测试终端用户的HCI和工具性能，方法是更密切地模仿临床工作流程，捕捉交互序列，同时评估计算机模块原型在临床工作流程中的功能。我们期望这种方法能够进一步补充和提供不同于有声思考分析的可用性发现。总之，这种混合方法评估为在实施之前对ADAPT系统进行迭代改进提供了全面和现实的反馈。该研究采用了两个阶段对一种新的交互式ADAPT工具进行测试，该工具将基于证据的共享目标设定组件嵌入到初级保健工作流程中，用于在商业医生办公室电子健康记录（EHR）中处理糖尿病前期咨询。第一阶段应用了可用性测试，包括对8个初级保健提供者与几个脚本化的临床场景进行交互的“大声思考”协议分析。第二阶段使用了“近现场”临床模拟，5名提供者与标准化训练的患者演员互动，为糖尿病前期患者提供咨询的临床场景，每个人都有一个计步器，记录一周内的步数。在这两个阶段，所有的会议都被录音，并激活了动作屏幕捕捉软件进行屏幕记录。使用迭代定性内容分析方法对转录本进行编码。在第一阶段，ADAPT的组件和布局对用户导航、可理解性和工作流的影响与最大数量的负面评论相关（即大约80%的最终用户评论），而适应性的可用性和内容则代表了更多的正面用户评论。可用性的启发式类别的正负评论比为2.1，反映了对工具的可用性、功能和ADAPT的整体协同生产利用的积极看法。然而，对于内容（即，如何在工具中显示、组织和描述信息）存在不同的看法。在第二阶段，患者接触的持续时间约为10分钟，所有的患者说明（处方）和行为契约在每次访问结束时被激活。在激活后，供应商100%接受工具规定的路径，并在模拟案例中完成工具中的所有字段。在击键和输入相关数据方面，只有14%的遇到时间花在使用ADAPT工具的功能上。其余的时间都花在沟通和对话上，以充实病人的指示。在所有病例中，回顾和讨论患者的运动和饮食的互动顺序与ADAPT工具在监测、反应效能、自我效能和患者-提供者对话中的协商方面的功能相关联。从单向对话转变为双向对话和协商，最终形成行为契约。这一变化证明了该工具的顺序，它支持记录当前的运动和饮食，然后设定饮食和运动目标，以降低糖尿病发病的风险。本研究表明，“有声思考”方案分析与“近现场”临床模拟为一种新的初级保健糖尿病前期共同目标设定工具提供了成功的可用性评估。研究的每个阶段都提供了对新屏幕工具问题的补充观察，并用于显示ADAPT框架对可用性、工作流集成以及患者和提供者之间沟通的影响。与提供者进行的有声思考测试表明，该工具可以根据ADAPT框架（运动到饮食的行为改变和工具使用）使用，而临床模拟显示，ADAPT框架可以实际支持患者与提供者沟通以获得行为改变合同。通过将“近现场”临床模拟与传统的“有声思考分析”相结合，可以更全面地捕捉到SDM相互作用和影响基于协议的护理的机制，从而提高临床医生的使用率。需要更多的分析来验证II期中发现的丰富的沟通行为是否与临床工作流程相辅相成。
Usability testing can be used to evaluate human computer interaction (HCI) and communication in shared decision making (SDM) for patient-provider behavioral change and behavioral contracting. Traditional evaluations of usability using scripted or mock patient scenarios with think-aloud protocol analysis provide a to identify HCI issues. In this paper we describe the application of these methods in the evaluation of the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) tool, and test the usability of the tool to support the ADAPT framework for integrated care counseling of pre-diabetes. The think-aloud protocol analysis typically does not provide an assessment of how patient-provider interactions are effected in “live” clinical workflow or whether a tool is successful. Therefore, “Near-live” clinical simulations involving applied simulation methods were used to compliment the think-aloud results. This complementary usability technique was used to test the end-user HCI and tool performance by more closely mimicking the clinical workflow and capturing interaction sequences along with assessing the functionality of computer module prototypes on clinician workflow. We expected this method to further complement and provide different usability findings as compared to think-aloud analysis. Together, this mixed method evaluation provided comprehensive and realistic feedback for iterative refinement of the ADAPT system prior to implementation. The study employed two phases of testing of a new interactive ADAPT tool that embedded an evidence-based shared goal setting component into primary care workflow for dealing with pre-diabetes counseling within a commercial physician office electronic health record (EHR). Phase I applied usability testing that involved “think-aloud” protocol analysis of 8 primary care providers interacting with several scripted clinical scenarios. Phase II used “near-live” clinical simulations of 5 providers interacting with standardized trained patient actors enacting the clinical scenario of counseling for pre-diabetes, each of whom had a pedometer that recorded the number of steps taken over a week. In both phases, all sessions were audio-taped and motion screen-capture software was activated for onscreen recordings. Transcripts were coded using iterative qualitative content analysis methods. In Phase I, the impact of the components and layout of ADAPT on user’s Navigation, Understandability, and Workflow were associated with the largest volume of negative comments (i.e. approximately 80% of end-user commentary), while Usability and Content of ADAPT were representative of more positive than negative user commentary. The heuristic category of Usability had a positive-to-negative comment ratio of 2.1, reflecting positive perception of the usability of the tool, its functionality, and overall co-productive utilization of ADAPT. However, there were mixed perceptions about content (i.e., how the information was displayed, organized and described in the tool). In Phase II, the duration of patient encounters was approximately 10 minutes with all of the Patient Instructions (prescriptions) and behavioral contracting being activated at the end of each visit. Upon activation, providers accepted the pathway prescribed by the tool 100% of the time and completed all the fields in the tool in the simulation cases. Only 14% of encounter time was spent using the functionality of the ADAPT tool in terms of keystrokes and entering relevant data. The rest of the time was spent on communication and dialogue to populate the patient instructions. In all cases, the interaction sequence of reviewing and discussing exercise and diet of the patient was linked to the functionality of the ADAPT tool in terms of monitoring, response-efficacy, self-efficacy, and negotiation in the patient-provider dialogue. There was a change from one-way dialogue to two-way dialogue and negotiation that ended in a behavioral contract. This change demonstrated the tool’s sequence, which supported recording current exercise and diet followed by a diet and exercise goal setting procedure to reduce the risk of diabetes onset. This study demonstrated that “think-aloud” protocol analysis with “near-live” clinical simulations provided a successful usability evaluation of a new primary care pre-diabetes shared goal setting tool. Each phase of the study provided complementary observations on problems with the new onscreen tool and was used to show the influence of the ADAPT framework on the usability, workflow integration, and communication between the patient and provider. The think-aloud tests with the provider showed the tool can be used according to the ADAPT framework (exercise-to-diet behavior change and tool utilization), while the clinical simulations revealed the ADAPT framework to realistically support patient-provider communication to obtain behavioral change contract. SDM interactions and mechanisms affecting protocol-based care can be more completely captured by combining “near-live” clinical simulations with traditional “think-aloud analysis” which augments clinician utilization. More analysis is required to verify if the rich communication actions found in Phase II compliment clinical workflows.
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DOI：
10.1197/jamia.m2231
发表时间：
2007-01-01
影响因子：
6.4
作者：
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影响因子：
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DOI：
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发表时间：
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期刊：
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影响因子：
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影响因子：
2.2
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DOI：
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发表时间：
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影响因子：
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作者：
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