Uptake of a Cervical Cancer Clinical Decision Support Tool: A Mixed-Methods Study.
Uptake of a Cervical Cancer Clinical Decision Support Tool: A Mixed-Methods Study.
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DOI：
10.1055/s-0043-1769913
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发表时间：
2023-05
影响因子：
2.9
通讯作者：
Gold, Rachel
中科院分区：
文献类型：
--
作者：
Huguet, Nathalie;Ezekiel-Herrera, David;Gunn, Rose;Pierce, Alison;O'Malley, Jean;Jones, Matthew;Marino, Miguel;Gold, Rachel
目的：临床决策支持（CDS）工具，提供床旁提醒患者的护理需求，可能会提高率的指南一致的宫颈癌筛查。 然而，在初级保健实践中，这种基于电子健康记录（EHR）的工具的使用率往往很低。本研究描述了与社区卫生中心网络中实施的宫颈癌筛查CDS工具（CC工具）相关的因素的频率，以及障碍和促进因素。 方法这种混合方法的顺序解释性研究报告CC工具的使用之间的480个社区为基础的诊所，位于18个州。 CC工具的采用被测量为工具使用的任何实例（即，宫颈癌筛查结果或随访计划的输入）以及2018年11月1日（工具发布日期）至2020年12月31日的每月工具使用率。使用logistic和负二项回归评估调整后的工具使用几率和比率。从9个诊所的工作人员代表6个诊所在以用户为中心的设计会议和半结构化的访谈与8个诊所的工作人员从另外两个诊所的反馈进行了评估的障碍和促进工具的采用。 结果在分析期间，41%的研究诊所使用CC工具≥1次。 平均而言，曾经使用过该工具的诊所和每月使用工具较多的诊所有更多的接触，更多的患者来自联邦贫困水平>138%的家庭，更少的儿科接触，更高的最新宫颈癌筛查率，以及更高的异常宫颈癌筛查结果率。定性数据表明了采用工具的障碍，包括缺乏对工具存在的了解、对其功能的理解以及对其使用的培训。 如果没有有效的系统来告知用户新的EHR功能，新的或更新的EHR工具不太可能被广泛采用，降低了它们改善医疗质量和结果的潜力。
Objectives Clinical decision support (CDS) tools that provide point-of-care reminders of patients' care needs may improve rates of guideline-concordant cervical cancer screening. However, uptake of such electronic health record (EHR)-based tools in primary care practices is often low. This study describes the frequency of factors associated with, and barriers and facilitators to adoption of a cervical cancer screening CDS tool (CC-tool) implemented in a network of community health centers. Methods This mixed-methods sequential explanatory study reports on CC-tool use among 480 community-based clinics, located across 18 states. Adoption of the CC-tool was measured as any instance of tool use (i.e., entry of cervical cancer screening results or follow-up plan) and as monthly tool use rates from November 1, 2018 (tool release date) to December 31, 2020. Adjusted odds and rates of tool use were evaluated using logistic and negative-binomial regression. Feedback from nine clinic staff representing six clinics during user-centered design sessions and semi-structured interviews with eight clinic staff from two additional clinics were conducted to assess barriers and facilitators to tool adoption. Results The CC-tool was used ≥1 time in 41% of study clinics during the analysis period. Clinics that ever used the tool and those with greater monthly tool use had, on average, more encounters, more patients from households at >138% federal poverty level, fewer pediatric encounters, higher up-to-date cervical cancer screening rates, and higher rates of abnormal cervical cancer screening results. Qualitative data indicated barriers to tool adoption, including lack of knowledge of the tool's existence, understanding of its functionalities, and training on its use. Conclusion Without effective systems for informing users about new EHR functions, new or updated EHR tools are unlikely to be widely adopted, reducing their potential to improve health care quality and outcomes.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1089/jwh.2017.6667
发表时间：
2018-05
期刊：
Journal of women's health (2002)
影响因子：
--
作者：
MacLaughlin KL;Kessler ME;Komandur Elayavilli R;Hickey BC;Scheitel MR;Wagholikar KB;Liu H;Kremers WK;Chaudhry R
通讯作者：
Chaudhry R
影响因子：
2.9
作者：
Ravikumar KE;MacLaughlin KL;Scheitel MR;Kessler M;Wagholikar KB;Liu H;Chaudhry R
通讯作者：
Chaudhry R
DOI：
10.1055/s-0041-1731005
发表时间：
2021
期刊：
ACI open
影响因子：
--
作者：
Gold R;Bunce A;Davis JV;Nelson JC;Cowburn S;Oakley J;Carney S;Horberg MA;Dearing JW;Melgar G;Bulkley JE;Seabrook J;Cloutier H
通讯作者：
Cloutier H
影响因子：
1.4
作者：
Tsui, Jennifer;Llanos, Adana A. M.;Stroup, Antoinette
通讯作者：
Stroup, Antoinette