Longitudinal adoption rates of complex decision support tools in primary care.
Longitudinal adoption rates of complex decision support tools in primary care.
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初级保健中复杂决策支持工具的纵向采用率。
DOI：
10.1136/ebmed-2014-110054
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
McGinn,Thomas
中科院分区：
文献类型：
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作者：
McCullagh,Lauren;Mann,Devin;Rosen,Lisa;Kannry,Joseph;McGinn,Thomas
将研究成果转化为实践有望改善护理。翻译包括在护理点整合循证指南，识别传播研究结果和模型的最佳方法，以持续实施最佳做法。通过将可用性测试应用于临床决策支持（CDS）设计，可以实现60%的总体采用率。尚未研究的是采用率持续多久以及与长期使用相关的特征。我们进行了二次分析，以破译影响持续使用CDS工具的因素。本研究是在纽约市的一家学术机构进行的临床试验的次要数据分析。研究数据是患者的电子健康记录（EHR）。该试验旨在测试将综合临床预测规则（iCPR）纳入EHR的实施情况。主要结局变量是iCPR工具对该工具的接受度。iCPR工具完成和iCPR最智能完成是其他关注的结果变量。第二个目的是检查与以后使用iCPR工具相关的用户特征。关注的特征包括年龄、居住年份、电子健康记录的使用（是/否）和最佳实践警报（BPA）的使用（是/否）。使用广义线性混合模型（GLiMM）比较iCPR使用随时间推移的每个关注结局：即iCPR接受、iCPR完成和iCPR智能集完成。GLiMM还用于检查与后期iCPR工具使用相关的居民特征;特别是中期和长期（即90天以上）。该工具在最初90天（短期）内的平均接受率为82.18%。 中期和长期使用率分别降至56.07%和45.61%。iCPR工具完成与时间段之间存在显著相关性（p<0.0001）。在中期和长期期间，住院医师之间的iCPR工具完成情况没有显著差异（p<0.6627）。iCPR smartset完成与时间段之间存在显著相关性（p<0.0021）。iCPR最聪明的完成与四个感兴趣的预测因素中的任何一个之间都没有显著的关联。我们检查了iCPR工具的组件随着时间的推移被各个临床医生接受的频率。随着时间的推移，该工具不同组成部分的采用率大幅下降。数据表明，随着时间的推移和长期接触CDS工具，供应商不太可能使用该工具。目前尚不清楚是否是CDS工具的疲劳、获得的临床预测规则知识或获得的临床经验和完形影响了采用率。应进一步分析随时间推移的个体采用率及其对临床结局的影响。
Translating research findings into practice promises to standardise care. Translation includes the integration of evidence-based guidelines at the point of care, discerning the best methods to disseminate research findings and models to sustain the implementation of best practices. By applying usability testing to clinical decision support (CDS) design, overall adoption rates of 60% can be realised. What has not been examined is how long adoption rates are sustained and the characteristics associated with long-term use. We conducted secondary analysis to decipher the factors impacting sustained use of CDS tools. This study was a secondary data analysis from a clinical trial conducted at an academic institution in New York City. Study data was deidentified patients’ electronic health records (EHR). The trial was to test the implementation of an integrated clinical prediction rule (iCPR) into the EHR. The primary outcome variable was iCPR tool acceptance of the tool. iCPR tool completion and iCPR smartest completion were additional outcome variables of interest. The secondary aim was to examine user characteristics associated with iCPR tool use in later time periods. Characteristics of interest included age, resident year, use of electronic health records (yes/no) and use of best practice alerts (BPA) (yes/no). Generalised linear mixed models (GLiMM) were used to compare iCPR use over time for each outcome of interest: namely, iCPR acceptance, iCPR completion and iCPR smartset completion. GLiMM was also used to examine resident characteristics associated with iCPR tool use in later time periods; specifically, intermediate and long-term (ie, 90+ days). The tool was accepted, on average, 82.18% in the first 90 days (short-term period). The use decreases to 56.07% and 45.61% in intermediate and long-term time periods, respectively. There was a significant association between iCPR tool completion and time periods (p<0.0001). There was no significant difference in iCPR tool completion between resident encounters in the intermediate and long-term periods (p<0.6627). There was a significant association between iCPR smartset completion and time periods (p<0.0021). There were no significant associations between iCPR smartest completion and any of the four predictors of interest. We examined the frequencies of components of the iCPR tool being accepted over time by individual clinicians. Rates of adoption of the different components of the tool decreased substantially over time. The data suggest that over time and prolonged exposure to CDS tools, providers are less likely to utilise the tool. It is not clear if it is fatigue with the CDS tool, acquired knowledge of the clinical prediction rule, or gained clinical experience and gestalt that are influencing adoption rates. Further analysis of individual adoption rates over time and the impact it has on clinical outcomes should be conducted.