User-centered design to improve clinical decision support in primary care
User-centered design to improve clinical decision support in primary care
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DOI：
10.1016/j.ijmedinf.2017.05.004
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发表时间：
2017-08-01
影响因子：
4.9
通讯作者：
Yano, Elizabeth M.
中科院分区：
文献类型：
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作者：
Brunner, Julian;Chuang, Emmeline;Yano, Elizabeth M.
背景资料：越来越多的文献表明，以用户为中心的设计，使临床决策支持系统更有效，更容易使用的能力。然而，以用户为中心的设计的研究很少检查超过少数网站的时间，并经常忽视的实施气候和组织资源，影响临床决策支持。一项系统性审查认为，纳入这些因素是“在卫生信息技术评价中可以取得的最重要的改进。“目标：（1）确定美国退伍军人事务部（VA）初级保健诊所四种以用户为中心的设计实践的流行程度，并评估这些诊所临床决策支持的感知效用;（2）评估这些以用户为中心的设计实践与临床决策支持的感知效用之间的关联。我们分析了2006-2007年从170个VA初级保健诊所收集的诊所级调查数据。我们研究了四种以用户为中心的设计实践：1）试点测试，2）提供商满意度评估，3）正式的可用性评估，以及4）对性能改进的影响分析。我们使用回归模型来评估以用户为中心的设计实践和临床决策支持的感知效用之间的关联，同时考虑这些诊所的其他重要因素，包括实施环境，可用资源和结构特征。我们还分别在社区为基础的诊所，并在医院为基础的clinics.Results：以用户为中心的临床决策支持的设计实践各不相同的诊所：74%进行试点测试，62%进行供应商满意度评估，36%进行了正式的可用性评估，79%进行了性能改进的影响分析。临床决策支持的总体感知效用很高，综合测量的平均评分为4.17（+/- .67）。“对性能改善的影响分析“是唯一与临床决策支持的感知效用显著相关的以用户为中心的设计实践，B =。47（p < .001）。这种关联存在于医院诊所，B =。34（p < .05），但在社区诊所更强，B =。61（p < .001）。结论：我们的研究结果高度支持分析临床决策支持对绩效指标影响的实践。在我们的研究中，这是最常见的以用户为中心的设计实践，并且是与临床决策支持的更高感知效用相关的实践。这种做法可能是特别有帮助的社区为基础的诊所，这是通常较少连接到VA医疗中心资源。
Background: A growing literature has demonstrated the ability of user-centered design to make clinical decision support systems more effective and easier to use. However, studies of user-centered design have rarely examined more than a handful of sites at a time, and have frequently neglected the implementation climate and organizational resources that influence clinical decision support. The inclusion of such factors was identified by a systematic review as "the most important improvement that can be made in health IT evaluations."Objectives: (1) Identify the prevalence of four user-centered design practices at United States Veterans Affairs (VA) primary care clinics and assess the perceived utility of clinical decision support at those clinics; (2) Evaluate the association between those user-centered design practices and the perceived utility of clinical decision support.Methods: We analyzed clinic-level survey data collected in 2006-2007 from 170 VA primary care clinics. We examined four user-centered design practices: 1) pilot testing, 2) provider satisfaction assessment, 3) formal usability assessment, and 4) analysis of impact on performance improvement. We used a regression model to evaluate the association between user-centered design practices and the perceived utility of clinical decision support, while accounting for other important factors at those clinics, including implementation climate, available resources, and structural characteristics. We also examined associations separately at community-based clinics and at hospital-based clinics.Results: User-centered design practices for clinical decision support varied across clinics: 74% conducted pilot testing, 62% conducted provider satisfaction assessment, 36% conducted a formal usability assessment, and 79% conducted an analysis of impact on performance improvement. Overall perceived utility of clinical decision support was high, with a mean rating of 4.17 (+/- .67) out of 5 on a composite measure. "Analysis of impact on performance improvement"was the only user-centered design practice significantly associated with perceived utility of clinical decision support, b =. 47 (p < .001). This association was present in hospital-based clinics, b =. 34 (p < .05), but was stronger at community-based clinics, b =. 61 (p < .001).Conclusions: Our findings are highly supportive of the practice of analyzing the impact of clinical decision support on performance metrics. This was the most common user-centered design practice in our study, and was the practice associated with higher perceived utility of clinical decision support. This practice may be particularly helpful at community-based clinics, which are typically less connected to VA medical center resources.