Evaluating informatics applications - some alternative approaches: theory, social interactionism, and call for methodological pluralism
Evaluating informatics applications - some alternative approaches: theory, social interactionism, and call for methodological pluralism
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DOI：
10.1016/s1386-5056(01)00184-8
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发表时间：
2001-11-01
影响因子：
4.9
通讯作者：
Kaplan, B
中科院分区：
文献类型：
--
作者：
Kaplan, B
关于CDSS的评价文献综述表明，随机对照临床试验（RCT）是评价的“金标准”。虽然这种方法非常适合研究系统或临床性能，但它不太适合回答有关是否使用系统或如何使用系统的问题。由于CDSS的使用不足，多年来一直受到关注，需要其他评价研究设计来解决这些问题。本文批评随机对照试验和实验评价方法，并提出了替代方法，以解决通常的随机对照试验和实验设计范围以外的问题的评价。广泛的文献进行了总结，以说明考虑到社会，组织，专业和其他背景因素的评价的价值。许多这些研究超越了系统性能或医生的行为的通常措施，专注于“适合”的系统与专业和组织生活的其他方面。由于很少有明确的理论，通知许多评价，然后审查CDSS评价通知社会科学理论。最后，提出了社会互动论的社会科学理论基础。给出了这种方法的一个例子。它涉及精神病学中的CDSS，并基于卡普兰的4C，重点是沟通，控制，护理和背景。虽然这个例子是一个CDSS，评估方法也是有用的临床指南的实施和其他医学信息学应用。同样，虽然讨论的是社会互动论，但更重要的一点是需要通过各种方法和途径来扩大评估，这些方法和途径调查社会、文化、组织、认知和其他背景问题。方法论的多元化和各种研究问题可以增加对信息学应用程序开发和部署的许多影响的理解。(C)Elsevier Science爱尔兰有限公司出版。
A review of evaluation literature concerning CDSSs indicates that randomized controlled clinical trials (RCTs) are the `gold standard' for evaluation. While this approach is excellent for studying system or clinical performance, it is not well suited to answering questions concerning whether systems will be used or how they will be used. Because lack of use of CDSS has been of concern for some years, other evaluation research designs are needed to address those issues. This paper critiques RCT and experimental evaluation approaches and presents alternative approaches to evaluation that address questions outside the scope of the usual RCT and experimental designs. A wide range of literature is summarized to illustrate the value of evaluations that take into account social, organizational, professional, and other contextual considerations. Many of these studies go beyond the usual measures of systems performance or physicians' behavior by focusing on `fit' of the system with other aspects of professional and organizational life. Because there is little explicit theory that informs many evaluations, the paper then reviews CDSS evaluations informed by social science theories. Lastly, it proposes a theoretical social science base of social interactionism. An example of such an approach is given. It involves a CDSS in psychiatry and is based on Kaplan's 4Cs, which focus on communication, control, care, and context. Although the example is a CDSS, the evaluation approach also is useful for clinical guideline implementation and other medical informatics applications. Similarly, although the discussion is about social interactionism, the more important point is the need to broaden evaluation through a variety of methods and approaches that investigate social, cultural, organizational, cognitive, and other contextual concerns. Methodological pluralism and a variety of research questions can increase understanding of many influences concerning informatics applications development and deployment. (C) 2001 Published by Elsevier Science Ireland Ltd.