Nudging Provider Adoption of Clinical Decision Support

摘要 随着长期的职业目标，成为一个领先的独立研究人员改变健康 信息技术，Safiya I。理查森，医学博士，公共卫生硕士，提出了一个指导研究项目和具体的 职业发展计划，这将使她准备使用行为科学来制定有效的临床决策 支持（CDS）。常规和基于证据的临床实践之间的差距是造成三分之一的 医院死亡和浪费估计每年380亿美元。计算机化CDS具有潜力， 通过在决策时向卫生保健提供者提供有意义和相关的证据来缩小这一差距 制作。然而，CDS治疗的适度改善受到持续低水平的限制。 供应商采用率，估计为10%。这个项目使用行为理论和行为的关键原则， 经济学，以阐明和解决障碍，提供商采用CDS。 使用能力机会动机行为（COM-B）框架，理查森博士将研究 提供者采用肺栓塞风险预测CDS工具的障碍。使用CDS评估预- CT肺血管造影前的检测概率降低了25%， 漏诊肺栓塞供应商的常规使用将导致减少600，000次扫描，减少84，000例 在美国预防3,000例恶性肿瘤和2,000例癌症死亡 每年的国家。本培训应用程序的总体目标是开发和评估 供应商采用包含轻推的新工具的可行性和初步功效 旨在解决工具使用的障碍。助推是行为科学的应用， 经济学家，被定义为积极的强化和间接的建议，有一个非强制性的影响， 决策。 该提案旨在：1）制定旨在解决已确定的行为障碍的推动措施， 2)构建并对新工具的原型进行迭代可用性测试，3）评估可行性， 在试点试验中，与现有工具相比，新工具对供应商采用的初步功效。这 项目采用多阶段混合方法框架。这是第一个评估的影响，轻推供应商 通过CDS。这项研究还辅之以职业发展活动，包括以下方面的正式培训： 健康信息学、行为科学、混合方法和临床试验设计。在一个 经验丰富的指导团队，拟议的研究和培训活动将导致开发一个 竞争性R 01赠款申请，以评估新工具改善健康结果的有效性。

ABSTRACT With the long term career goal of becoming a leading independent researcher transforming health information technology, Safiya I. Richardson, MD, MPH, proposes a mentored research project and specific career development plan which will prepare her to use behavioral science to develop effective clinical decision support (CDS). The disparity between usual and evidenced based clinical practice is responsible for a third of hospital deaths and waste estimated at 380 billon dollars each year. Computerized CDS has the potential to narrow this gap by bringing meaningful and relevant evidence to health care providers at the point of decision making. However, moderate improvements in care seen with CDS are significantly limited by consistently low provider adoption, estimated at 10%. This project uses behavioral theory and key principles of behavioral economics to illuminate and address barriers to provider adoption of CDS. Using the Capability Opportunity Motivation Behavior (COM-B) framework Dr. Richardson will examine barriers to provider adoption of a pulmonary embolism risk prediction CDS tool. The use of CDS to assess pre- test probability before computed tomography pulmonary angiography reduces testing by 25% without any missed pulmonary emboli. Routine use by providers would result in 600,000 fewer scans, 84,000 fewer cases of contrast induced nephropathy and prevent 3,000 malignancies as well as 2,000 cancer deaths in the United States every year. The overall objective of this training application is to develop and evaluate the feasibility and preliminary efficacy on provider adoption of a new tool that incorporates nudges designed to address barriers to tool use. Nudges are applications of behavioral science used by behavioral economists, defined as positive reinforcement and indirect suggestions which have a non-forced effect on decision making. The proposal aims to: 1) develop nudges designed to address identified behavioral barriers to adoption, 2) build and conduct iterative usability testing on prototypes of the new tool, 3) evaluate the feasibility and preliminary efficacy on provider adoption of the new tool compared to the current tool, in a pilot trial. This project uses a multistage mixed methods framework. It is the first to evaluate the impact of nudges on provider adoption of CDS. This research is complemented by career development activities, including formal training in health informatics, behavioral science, mixed methods and clinical trial design. With the guidance of an experienced mentoring team, the proposed research and training activities will lead to the development a competitive R01 grant application to assess the effectiveness of the new tool to improve health outcomes.