User Requirements for a Chronic Kidney Disease Clinical Decision Support Tool to Promote Timely Referral.
User Requirements for a Chronic Kidney Disease Clinical Decision Support Tool to Promote Timely Referral.
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DOI：
10.1016/j.ijmedinf.2017.01.018
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发表时间：
2017-05
影响因子：
4.9
通讯作者：
Samal L
中科院分区：
文献类型：
--
作者：
Gulla J;Neri PM;Bates DW;Samal L
CKD患者的及时转诊与成本和死亡率效益相关，但转诊往往在疾病过程中进行得太晚。临床决策支持(CDS)提供了一个潜在的解决方案，但干预措施失败了，因为它们的设计不是为了支持医生的工作流程。我们试图确定慢性肾脏疾病(CKD)CDS系统的用户需求，以促进及时转诊。我们采访了初级保健医生(PCP)，以确定CKD CDS系统的数据需求，该系统将鼓励及时转诊，并收集有关工作流程的信息，以评估CKD进展的风险因素。受访者是从布里格姆妇女医院(BWH)附属的14家初级保健诊所网络招募的普通内科医生。然后，我们进行了定性分析，以确定CKD CDS系统的用户需求和系统属性。在12名参与者中，25%是女性，平均年龄53岁(37-82岁)，平均临床实践年限27年(11-58岁)。我们确定了21项用户需求。这些用户要求中有7项涉及对转介程序工作流程的支持，包括获取相关信息和支持纵向共同管理。6个用户需求与慢性肾脏病的PCP管理相关，包括进展的风险因素的管理，慢性肾脏病严重程度的生物标志物的解释，以及慢性肾脏病的病因诊断。最后，八项用户要求涉及以用户为中心的CDS设计，包括需要可操作的信息、指南和参考材料的链接以及趋势的可视化。这21个用户需求可以用来设计一个直观和可用的CDS系统，该系统具有促进及时转诊所必需的属性。
Timely referral of patients with CKD has been associated with cost and mortality benefits, but referrals are often done too late in the course of the disease. Clinical decision support (CDS) offers a potential solution, but interventions have failed because they were not designed to support the physician workflow. We sought to identify user requirements for a chronic kidney disease (CKD) CDS system to promote timely referral. We interviewed primary care physicians (PCPs) to identify data needs for a CKD CDS system that would encourage timely referral, and also gathered information about workflow to assess risk factors for progression of CKD. Interviewees were general internists recruited from a network of 14 primary care clinics affiliated with Brigham and Women’s Hospital (BWH). We then performed a qualitative analysis to identify user requirements and system attributes for a CKD CDS system. Of the twelve participants, 25% were women, the mean age was 53 (range 37–82), mean years in clinical practice was 27 (range 11–58). We identified 21 user requirements. Seven of these user requirements were related to support for the referral process workflow, including access to pertinent information and support for longitudinal co-management. Six user requirements were relevant to PCP management of CKD, including management of risk factors for progression, interpretation of biomarkers of CKD severity, and diagnosis of the cause of CKD. Finally, eight user requirements addressed user-centered design of CDS, including the need for actionable information, links to guidelines and reference materials, and visualization of trends. These 21 user requirements can be used to design an intuitive and usable CDS system with the attributes necessary to promote timely referral.