Examining Care Planning Efficiency and Clinical Decision Support Adoption in a System Tailoring to Nurses' Graph Literacy: National, Web-Based Randomized Controlled Trial.
Examining Care Planning Efficiency and Clinical Decision Support Adoption in a System Tailoring to Nurses' Graph Literacy: National, Web-Based Randomized Controlled Trial.
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DOI：
10.2196/45043
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发表时间：
2023-08-11
影响因子：
7.4
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中科院分区：
文献类型：
--
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电子健康记录(EHR)中健康护理数据的激增推动了对临床决策支持(CDS)的需求，CDS可确保准确性并减少认知处理和文档负担。CDS格式可以在实现预期结果方面发挥关键作用。在我们对来自美国中西部1个大都市区的60名注册护士(RN)进行的实验室试点研究的基础上，我们对203名注册护士进行了一项全面、创新、全国性和基于网络的随机对照试验，该研究表明了图形素养(GL)的重要性。这项研究旨在比较护理计划时间(CPT)和循证CDS建议的采纳情况，RN随机分配到4个CDS格式组中的一个：纯文本(TO)、文本+表格(TT)、文本+图表(TG)和定制(基于RN的GL分数)。我们假设定制的CDS组将比3个非定制的CDS组拥有更快的CPT(主要)和更高的采用率(次要)。在过去两年中，从代表美国5个地区(东北部、东南部、中西部、西南部和西部)的10个州护理委员会名单中随机招募符合条件的RN参加随机对照试验。RN被随机分配到4个CDS格式组中的一个-TO、TT、TG和定制(基于RN的GL评分)-并在他们的PC上与干预互动。通过回归分析来评估剪裁的效果以及CPT和RN特征之间的关联。定制CDS组(n=46)与非定制CDS组(TO，n=55；TT，n=54；TG，n=48)之间的CPT和CDS采用率均无显著差异。与TO CDS格式相比，具有低GL的RNS与TG CDS格式的CPT相互作用时间更长(P=0.01)。TGCDS格式的CPT与年龄(P=0.02)、血糖(P=0.02)和对EHR的舒适度(P=0.047)相关。在TT CDS格式中，与EHR的舒适度也与CPT相关(P<；.001)。尽管基于GL的定制没有提高CPT或采用率，但这项研究强化了之前的试点研究结果，即当图表包括在护理计划CDS中时，低GL与较长的CPT相关。血糖指数越高、年龄越小、对EHR的舒适度越高，CPT越短。这些发现基于我们新的创新测试策略，在该策略中，不同的全国RN参与者样本(随机来自10个州护士委员会名单)在网络上与他们个人电脑上的干预互动。建议应用我们的创新方法进行未来的研究，以具有成本效益的方式提高对RN的GL如何结合其他因素，在实践中使用之前为护理规划和其他EHR组成部分开发有效的CDS的理解。
The proliferation of health care data in electronic health records (EHRs) is fueling the need for clinical decision support (CDS) that ensures accuracy and reduces cognitive processing and documentation burden. The CDS format can play a key role in achieving the desired outcomes. Building on our laboratory-based pilot study with 60 registered nurses (RNs) from 1 Midwest US metropolitan area indicating the importance of graph literacy (GL), we conducted a fully powered, innovative, national, and web-based randomized controlled trial with 203 RNs. This study aimed to compare care planning time (CPT) and the adoption of evidence-based CDS recommendations by RNs randomly assigned to 1 of 4 CDS format groups: text only (TO), text+table (TT), text+graph (TG), and tailored (based on the RN’s GL score). We hypothesized that the tailored CDS group will have faster CPT (primary) and higher adoption rates (secondary) than the 3 nontailored CDS groups. Eligible RNs employed in an adult hospital unit within the past 2 years were recruited randomly from 10 State Board of Nursing lists representing the 5 regions of the United States (Northeast, Southeast, Midwest, Southwest, and West) to participate in a randomized controlled trial. RNs were randomly assigned to 1 of 4 CDS format groups—TO, TT, TG, and tailored (based on the RN’s GL score)—and interacted with the intervention on their PCs. Regression analysis was performed to estimate the effect of tailoring and the association between CPT and RN characteristics. The differences between the tailored (n=46) and nontailored (TO, n=55; TT, n=54; and TG, n=48) CDS groups were not significant for either the CPT or the CDS adoption rate. RNs with low GL had longer CPT interacting with the TG CDS format than the TO CDS format (P=.01). The CPT in the TG CDS format was associated with age (P=.02), GL (P=.02), and comfort with EHRs (P=.047). Comfort with EHRs was also associated with CPT in the TT CDS format (P<.001). Although tailoring based on GL did not improve CPT or adoption, the study reinforced previous pilot findings that low GL is associated with longer CPT when graphs were included in care planning CDS. Higher GL, younger age, and comfort with EHRs were associated with shorter CPT. These findings are robust based on our new innovative testing strategy in which a diverse national sample of RN participants (randomly derived from 10 State Board of Nursing lists) interacted on the web with the intervention on their PCs. Future studies applying our innovative methodology are recommended to cost-effectively enhance the understanding of how the RN’s GL, combined with additional factors, can inform the development of efficient CDS for care planning and other EHR components before use in practice.
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影响因子：
4.9
作者：
Anders S;Albert R;Miller A;Weinger MB;Doig AK;Behrens M;Agutter J
通讯作者：
Agutter J
影响因子：
3
作者：
BERTRAM, DA;OPILA, DA;HERSHEY, CO
通讯作者：
HERSHEY, CO
影响因子：
3.2
作者：
Cornish, Lillian;Hill, Andrew;Watson, Marcus O.
通讯作者：
Watson, Marcus O.
影响因子：
2.4
作者：
Ayres, Paul;Paas, Fred
通讯作者：
Paas, Fred
影响因子：
6.1
作者：
DELACRETAZ, AC;FRUTIGER, P
通讯作者：
FRUTIGER, P