Health IT-supported process for preventing and managing VTE

描述(申请人提供)：静脉血栓栓塞症(VTE)对于住院患者来说仍然是一种常见但可预防的并发症，可导致显著的发病率和死亡率。据估计，美国每年发生的VTE病例超过90万例。对一系列VTE预防干预措施进行了评估，例如用于VTE风险评估的电子提醒和临床决策支持(CDS)。健康信息(IT)可能为改善VTE的预防和管理提供机会。然而，基于计算机化的VTE风险评估的电子警报研究产生的好处有限。这些研究仅限于高危患者，侧重于预防(即VTE预防)，很少或根本没有考虑VTE的诊断和治疗(即VTE管理)，并且没有解决许多报告中确定的与CDS设计相关的社会技术挑战。我们建议使用社会技术系统方法来设计专门用于预防和管理VTE的卫生信息技术；这种方法可以解决限制卫生信息技术对VTE有效性的一系列社会技术系统问题。使用SEIPS模型和人的因素多层次系统模型，我们将深入了解VTE预防和管理中涉及的认知和团队工作，然后使用此分析的输出来定义CDS的社会技术设计要求，以支持预防和管理VTE的认知和团队工作。我们的具体目标是：(1)评估预防和管理VTE所涉及的认知和团队工作；以及(2)制定支持预防和管理VTE的认知和团队工作的CDS的设计要求。这项研究将在一个综合医疗系统的四家医院进行。分析认知和团队工作的方法将是多样化的(即观察、访谈、焦点小组和调查)(目标1)，并将产生一系列输出(例如，决策阶梯、流程图、信息流程图)，用于确定CDS设计要求(目标2)。利用人为因素工程师和研究团队中的医生之间的协作过程，我们将制定初步设计要求，这些要求将嵌入CDS模型；然后将通过基于场景的可用性评估和小组汇报对CDS模型进行评估。这一分析的结果将有助于确定在目标1的数据收集中要解决的其他问题。 所有目标1的数据已经收集和分析，我们将最终确定CDS设计要求(目标2)。这项研究侧重于VTE，但更广泛的目标是开发一种方法来设计针对医疗质量和安全问题的医疗IT应用程序，该方法可以受益于临床工作流程中指南的改进集成。这项研究具有重大意义和创新性，因为我们正在(A)解决一种常见但可预防的并发症，即VTE；(B)使用社会技术系统方法和人为因素原则和方法来设计医疗IT；以及(C)涉及一支由人为因素工程师和医生组成的经验丰富的多学科团队。

DESCRIPTION (provided by applicant): Venous thromboembolism (VTE) remains a frequent, but preventable complication for hospitalized patients that can lead to significant morbidity and mortality. It has been estimated that more than 900,000 VTE cases occur in the US every year. A range of VTE prevention interventions have been evaluated, such as electronic reminders and clinical decision support (CDS) for VTE risk assessment. Health information (IT) may provide an opportunity for improving the prevention and management of VTE. However, studies of electronic alerts based on computerized VTE risk assessment have produced limited benefits. These studies have been restricted to high-risk patients, have focused on prophylaxis (i.e. VTE prevention) with little or no consideration for VTE diagnosis and treatment (i.e. VTE management), and have not addressed sociotechnical challenges related to CDS design identified in numerous reports. We propose to use a sociotechnical systems approach to the design of health IT specifically for preventing and managing VTE; this approach can address the range of sociotechnical system issues that have limited the effectiveness of health IT for VTE. Using the SEIPS model and the human factors multi-level system model, we will develop a deep understanding of the cognitive and team work involved in VTE prevention and management, and then use the outputs of this analysis to define sociotechnical design requirements for a CDS that supports cognitive and team work for preventing and managing VTE. Our specific aims are: (1) to evaluate the cognitive and team work involved in VTE prevention and management; and (2) to develop design requirements for a CDS that supports cognitive and team work for preventing and managing VTE. The study will be conducted in four hospitals of an integrated healthcare system. Methods for analyzing cognitive and team work will be diverse (i.e. observation, interview, focus group and survey) (Aim 1) and will produce a range of outputs (e.g., decision ladders, process map, information flow diagram) that will be used to define the CDS design requirements (Aim 2). Using a collaborative process between the human factors engineers and the physicians on the research team, we will develop preliminary design requirements that will be embedded in CDS mock-ups; the CDS mock-ups will then be evaluated through scenario-based usability evaluation and group debriefings. The results of this analysis will help to define additional questions to address in the data collection for Aim 1. When all Aim 1 data have been collected and analyzed, we will finalize the CDS design requirements (Aim 2). This research focuses on VTE, but the broader objective is to develop an approach to design health IT applications for healthcare quality and safety problems that can benefit from improved integration of guidelines in clinical workflows. This study is significant and innovative because we are (a) addressing a common, but preventable complication, i.e. VTE; (b) using a sociotechnical systems approach and human factors principles and methods to design health IT; and (c) involving a highly experienced multidisciplinary team of human factors engineers and physicians.