Stakeholder Perspectives on an Inpatient Hypoglycemia Informatics Alert: Mixed Methods Study.
Stakeholder Perspectives on an Inpatient Hypoglycemia Informatics Alert: Mixed Methods Study.
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DOI：
10.2196/31214
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发表时间：
2021-11-26
影响因子：
2.7
通讯作者：
Golden SH
中科院分区：
文献类型：
--
作者：
Mathioudakis N;Aboabdo M;Abusamaan MS;Yuan C;Lewis Boyer L;Pilla SJ;Johnson E;Desai S;Knight A;Greene P;Golden SH
医源性低血糖在住院患者中很常见，与不良临床结局和死亡率增加相关。临床决策支持系统可用于降低这种潜在可避免的不良事件的发生率。本研究旨在确定实时信息警报的预期特征和功能，以预防医院环境中的医源性低血糖。使用机构的医疗保健研究和质量有效的临床决策支持框架的五个权利，我们进行了一项混合方法的研究，使用电子调查和焦点小组会议的医院为基础的供应商。其目的是征求利益相关者的意见，以告知未来针对医源性低血糖的实时信息学警报的开发。除了对问题的重要性和现有障碍的看法外，我们还寻求有关警报的内容，格式，渠道，时间和接收者（即五项权利）的输入。采用演绎法和归纳法对焦点小组会议进行了专题分析。一个21项电子调查完成了102住院为基础的供应商，随后2个焦点小组会议（6供应商每届会议）。受访者普遍同意或强烈同意，住院医源性低血糖是一个重要的问题，可以解决的信息警报。利益相关者表示更喜欢非侵入性、准确、接近真实的时间传达给订购供应商的警报，并提供可操作的治疗建议。几种电子病历工具，包括患者标题中的警报指示符、血糖管理报告和实验室结果部分，被认为是可接受的格式。对警觉疲劳的担忧在调查受访者和焦点小组参与者中普遍存在。在这项研究中确定的设计偏好将提供一个信息学团队开发一个原型警报试点测试和评估所需的框架。此警报将有助于满足医院临床医生的需求，这些医生负责照顾处于治疗相关低血糖高风险中的糖尿病患者。
Iatrogenic hypoglycemia is a common occurrence among hospitalized patients and is associated with poor clinical outcomes and increased mortality. Clinical decision support systems can be used to reduce the incidence of this potentially avoidable adverse event. This study aims to determine the desired features and functionality of a real-time informatics alert to prevent iatrogenic hypoglycemia in a hospital setting. Using the Agency for Healthcare Research and Quality Five Rights of Effective Clinical Decision Support Framework, we conducted a mixed methods study using an electronic survey and focus group sessions of hospital-based providers. The goal was to elicit stakeholder input to inform the future development of a real-time informatics alert to target iatrogenic hypoglycemia. In addition to perceptions about the importance of the problem and existing barriers, we sought input regarding the content, format, channel, timing, and recipient for the alert (ie, the Five Rights). Thematic analysis of focus group sessions was conducted using deductive and inductive approaches. A 21-item electronic survey was completed by 102 inpatient-based providers, followed by 2 focus group sessions (6 providers per session). Respondents universally agreed or strongly agreed that inpatient iatrogenic hypoglycemia is an important problem that can be addressed with an informatics alert. Stakeholders expressed a preference for an alert that is nonintrusive, accurate, communicated in near real time to the ordering provider, and provides actionable treatment recommendations. Several electronic medical record tools, including alert indicators in the patient header, glucose management report, and laboratory results section, were deemed acceptable formats for consideration. Concerns regarding alert fatigue were prevalent among both survey respondents and focus group participants. The design preferences identified in this study will provide the framework needed for an informatics team to develop a prototype alert for pilot testing and evaluation. This alert will help meet the needs of hospital-based clinicians caring for patients with diabetes who are at a high risk of treatment-related hypoglycemia.
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影响因子：
17.1
作者：
Henry, Katharine E.;Hager, David N.;Saria, Suchi
通讯作者：
Saria, Suchi
影响因子：
105.7
作者：
Kwan, Janice L.;Lo, Lisha;Shojania, Kaveh G.
通讯作者：
Shojania, Kaveh G.
影响因子：
3.5
作者：
Ancker JS;Edwards A;Nosal S;Hauser D;Mauer E;Kaushal R;with the HITEC Investigators
通讯作者：
with the HITEC Investigators
影响因子：
--
作者：
Jenders, R A
通讯作者：
Jenders, R A
影响因子：
105.7
作者：
Kawamoto, K;Houlihan, CA;Lobach, DF
通讯作者：
Lobach, DF