User centered clinical decision support tools: adoption across clinician training level.
User centered clinical decision support tools: adoption across clinician training level.
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DOI：
10.4338/aci-2014-05-ra-0048
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发表时间：
2014-01-01
影响因子：
2.9
通讯作者：
McGinn, T G
中科院分区：
文献类型：
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作者：
McCullagh, L J;Sofianou, A;McGinn, T G
背景技术背景：临床决策支持（CDS）工具的传播和采用是《平价医疗法案》有意义使用计划的一项主要举措。CDS工具的采用是多管齐下的，个人、组织和临床环境都是成功利用率的因素。具体而言，创新理论的传播意味着“早期采用者”更倾向于使用CDS工具，年轻的医生往往被列为这一类。目的：本研究探讨了不同培训水平的供应商在采用CDS工具方面的差异。从2010年11月至2011年，168名住院医师和主治医师从一个学术医疗机构参加了一项随机对照试验。干预：干预组在链球菌和肺炎患者访视期间通过电子健康记录（EHR）系统访问CDS工具。主要测量：EHR系统记录了干预组如何与CDS工具互动的详细信息，包括接受初始CDS警报、完成风险评分计算器和签署药物订单集。使用EHR数据，该研究进行了双变量测试和一般估计方程（GEE）建模，以检查在通过CDS工具在居民和attendings.Key结果的差异：CDS计算器和药物顺序集的完成率较高的第一年居民相比，所有其他培训水平。主治医生不太可能接受CDS工具（29.3%）的初始步骤或完成的药物顺序集（22.4%），指导他们的处方决策，导致主治医生订购更多的抗生素（37.1%）在CDS遇到相比resident.CONCLUSION：有变化，通过CDS工具的培训水平。主治医生倾向于接受较少的工具，但订购更多的药物。CDS工具应适合临床医生的培训水平。
BACKGROUND: Dissemination and adoption of clinical decision support (CDS) tools is a major initiative of the Affordable Care Act's Meaningful Use program. Adoption of CDS tools is multipronged with personal, organizational, and clinical settings factoring into the successful utilization rates. Specifically, the diffusion of innovation theory implies that 'early adopters' are more inclined to use CDS tools and younger physicians tend to be ranked in this category.OBJECTIVE: This study examined the differences in adoption of CDS tools across providers' training level.PARTICIPANTS: From November 2010 to 2011, 168 residents and attendings from an academic medical institution were enrolled into a randomized controlled trial.INTERVENTION: The intervention arm had access to the CDS tool through the electronic health record (EHR) system during strep and pneumonia patient visits.MAIN MEASURES: The EHR system recorded details on how intervention arm interacted with the CDS tool including acceptance of the initial CDS alert, completion of risk-score calculators and the signing of medication order sets. Using the EHR data, the study performed bivariate tests and general estimating equation (GEE) modeling to examine the differences in adoption of the CDS tool across residents and attendings.KEY RESULTS: The completion rates of the CDS calculator and medication order sets were higher amongst first year residents compared to all other training levels. Attendings were the less likely to accept the initial step of the CDS tool (29.3%) or complete the medication order sets (22.4%) that guided their prescription decisions, resulting in attendings ordering more antibiotics (37.1%) during an CDS encounter compared to residents.CONCLUSION: There is variation in adoption of CDS tools across training levels. Attendings tended to accept the tool less but ordered more medications. CDS tools should be tailored to clinicians' training levels.