A Framework for Usable and Effective Clinical Decision Support: Experience from the iCPR Randomized Clinical Trial.
A Framework for Usable and Effective Clinical Decision Support: Experience from the iCPR Randomized Clinical Trial.
复制标题
可用有效的临床决策支持的框架：ICPR随机临床试验的经验。
DOI：
10.13063/2327-9214.1150
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
McGinn T
中科院分区：
文献类型：
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作者：
Kannry J;McCullagh L;Kushniruk A;Mann D;Edonyabo D;McGinn T
临床决策支持（CDS）的承诺一直是通过提供及时和适当的建议来改变患者护理和改善患者结局，这些建议是针对患者的，并且通常是可适当操作的。然而，CDS提供者的用户经常受到不适当和不适用的CDS的轰炸，这些CDS通常不是信息性的，没有集成到工作流程中，没有患者特异性，并且可能提出过时和不相关的建议。综合临床预测规则（iCPR）项目是一项随机临床试验（RCT），旨在确定一种新型CDS，即，临床预测规则（CPR）可以被有效地集成到工作流程中并导致结果的改变（例如，抗生素订购）时嵌入在商业电子健康记录（EHR）。我们使用从iCPR项目中吸取的经验教训来说明一个框架，用于构建可用，有用和有效的可操作CDS，同时在生产系统中使用现成的功能。构成该框架的创新联合收割机以下内容：（1）主动和可操作的决策支持，（2）多轮可用性测试和迭代开发，以获得用户接受度，（3）众多上下文敏感触发器，（4）为CDS工具的用户提供专门的培训和支持，以供用户采用，以及（5）来自临床和行政领导的支持。我们将“上下文敏感触发器”定义为工作流事件（即，这导致CDS干预。框架的成功可以通过CDS采用来衡量（即，正在使用的干预）、接受（符合建议）和临床结果（适当时）。这一框架可能对卫生信息技术（HIT）的部署产生更广泛的影响。iCPR被广泛采用（57.4%的用户）和接受（42.7%的用户）。在iCPR RCT之前，可用性测试确定并修复了许多问题。对iCPR的领导支持和临床指导水平是建立接受该工具及其建议的文化的关键，有助于采用和接受。专门的培训和支持导致大多数居民报告对iCPR工具链球菌性咽炎（64.4%）和肺炎（62.7%）的舒适度很高，并且将来使用这些工具的可能性很高。一个令人惊讶的框架增加了可用性测试：上下文敏感的触发器。
The promise of Clinical Decision Support (CDS) has always been to transform patient care and improve patient outcomes through the delivery of timely and appropriate recommendations that are patient specific and, more often than not, are appropriately actionable. However, the users of CDS—providers—are frequently bombarded with inappropriate and inapplicable CDS that often are not informational, not integrated into the workflow, not patient specific, and that may present out of date and irrelevant recommendations. The integrated clinical prediction rule (iCPR) project was a randomized clinical trial (RCT) conducted to determine if a novel form of CDS, i.e., clinical prediction rules (CPRs), could be efficiently integrated into workflow and result in changes in outcomes (e.g., antibiotic ordering) when embedded within a commercial electronic health record (EHR). We use the lessons learned from the iCPR project to illustrate a framework for constructing usable, useful, and effective actionable CDS while employing off-the-shelf functionality in a production system. Innovations that make up the framework combine the following: (1) active and actionable decision support, (2) multiple rounds of usability testing with iterative development for user acceptance, (3) numerous context sensitive triggers, (4) dedicated training and support for users of the CDS tool for user adoption, and (5) support from clinical and administrative leadership. We define “context sensitive triggers” as being workflow events (i.e., context) that result in a CDS intervention. Success of the framework can be measured by CDS adoption (i.e., intervention is being used), acceptance (compliance with recommendations), and clinical outcomes (where appropriate). This framework may have broader implications for the deployment of Health Information Technology (HIT). iCPR was well adopted(57.4% of users) and accepted (42.7% of users). Usability testing identified and fixed many issues before the iCPR RCT. The level of leadership support and clinical guidance for iCPR was key in establishing a culture of acceptance for both the tool and its recommendations contributing to adoption and acceptance. The dedicated training and support lead to the majority of the residents reporting a high level of comfort with both iCPR tools strep pharyngitis (64.4 percent) and pneumonia (62.7 percent) as well as a high likelihood of using the tools in the future. A surprising framework addition resulted from usability testing: context sensitive triggers.