Provider Attitudes Toward the Implementation of Clinical Decision Support Tools in Dental Practice
Provider Attitudes Toward the Implementation of Clinical Decision Support Tools in Dental Practice
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DOI：
10.1016/j.jebdp.2015.09.001
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发表时间：
2015-12-01
影响因子：
3.6
通讯作者：
White, Joel
中科院分区：
文献类型：
--
作者：
Mertz, Elizabeth;Bolarinwa, Olumide;White, Joel
目的：本文的目的是评估临床牙科提供者的基线知识和态度的实施三个临床决策支持（CDS）工具内置到电子健康记录（EHR）的多专业组牙科实践。程序：一项旨在研究接受EHR工具的诱发因素的电子调查，通过风险评估和基于风险评估的主动牙科保健计划进行龋齿和牙周病管理，分发给所有威拉米特牙科集团（WDG）的员工。这项调查收集了人口统计学数据，沿着测量工作经验和满意度，对牙科信息技术的舒适度，以及对每种CDS工具的态度和知识。WDG提供了关于现场一级患者和融资组合、患者满意度数据、员工角色（例如牙医）和公司任期的数据。该调查是在2013年11月推出CDS工具前3个月进行的。该调查以电子方式分发给所有WDG员工（n = 1166），其中58.5%（n = 682）是临床医生，位于俄勒冈州、华盛顿和爱达荷州的53个地点。总应答率为79.8%（n = 930），所有临床医生的应答率为83.1%（n = 567）。其中，24.3%是一般和专科牙医（n = 138），26.6%是牙科医师（n = 151），49%是牙科助理（n = 278）。主要调查结果：临床医生调查报告说，非常适合实施的三个CDS工具。临床医生的态度反映了更高的预期改善病人护理和质量比业务流程，由于实施。临床医生的特征与CDS工具实施的积极态度最密切相关（根据Likert量表I =低至5 =高）包括对EHR的满意度（0.499，rho < 0.001），工作满意度（0.458，ρ < 0.001），发现变化是令人兴奋的（0.398，rho < 0.001），对工作的控制感（0.352，ρ < 0.001），以及拥有足够工具完成工作的感知（0.340，ρ < 0.001）。报告频率较高（1 =从不，7 =总是）（-0.297，rho < 0.001），感觉情绪枯竭（-0.265，rho < 0.001），感觉工作是一种应变（-0.205，rho < 0.001）与消极态度的相关性最大。这是第一项研究，以检查牙科提供者的态度，实施CDS工具纳入电子健康记录。供应商对CDS工具的态度可以塑造整个实施过程，无论是好是坏。这项研究有助于文献提供了一个系统的变化开始时的积极态度相关的因素的理解，可以帮助指导组织管理人员更好地准备他们的劳动力和组织采用循证牙科工具，如CDS系统。
Purpose: The objective of this paper is to assess clinical dental providers' baseline knowledge and attitudes about the implementation of three clinical decision support (CDS) tools built into the electronic health record (EHR) of a multi-specialty group dental practice.Procedures: An electronic survey designed to examine predisposing factors for acceptance of EHR-based tools, caries and periodontal disease management by risk assessment and a risk assessment-based Proactive Dental Care Plan, was distributed to all Willamette Dental Group (WDG) employees. The survey collected demographic data, along with measures of job experience and satisfaction, comfort with dental information technology, and attitudes and knowledge of each CDS tool. WDG provided data on site-level patient and financing mix, patient satisfaction data, employee role (e.g. dentist) and tenure with company. The survey was conducted 3 months prior to the rollout of the CDS tools in November 2013. The survey was distributed electronically to all WDG employees (n = 1166), of whom 58.5% (n = 682) were clinicians, located in 53 sites in Oregon, Washington and Idaho. The overall response rate was 79.8% (n = 930), with a response rate of 83.1% (n = 567) from all clinicians. Of these, 24.3% were general and specialist dentists (n = 138); 26.6% were dental hygienists (n = 151), and 49% were dental assistants (n = 278).Principal Findings: The clinicians surveyed reported being highly amenable to implementation of the three CDS tools. Clinicians' attitudes reflected higher expected improvement in patient care and quality than in business processes due to the implementation. The clinician characteristics most strongly correlated with a positive attitude toward the CDS tool implementation (as measured on Likert scale I = low to 5 = high) included satisfaction with the EHR (0.499, rho < 0.001), job satisfaction (0.458, rho < 0.001), finding change to be exciting (0.398, rho < 0.001), degree of control perceived over work (0.352, rho < 0.001), and a perception of having adequate tools to get work done (0.340, rho < 0.001). Higher reported frequency (scale 1 = never, 7 = always) of feeling burned out (-0.297, rho < 0.001), feeling emotionally drained (-0.265, rho < 0.001), and feeling work is a strain (-0.205, rho < 0.001) had the greatest correlation with negative attitudes.Conclusion: This is the first study to examine dental provider attitudes toward the implementation of CDS tools incorporated within an electronic health record. Provider attitudes toward CDS tools can shape the entire implementation process for better or worse. This study contributes to the literature by providing an understanding of factors related to positive attitudes at the outset of a system change and can help guide organizational administrators to better prepare their workforce and organization for adoption of evidence-based dentistry tools such as a CDS system.