Patient Safety through Implementation Science: Clinical Work Culture & IT Design

描述(由申请人提供)： 这项K99/R00职业发展建议的长期目标是改善信息学工具与日常临床实践之间的互动。这项提案的一个核心前提是，可以通过信息学技术改善用药安全，从而更好地支持临床医生和患者使用的安全生产程序。PI是一名医学和组织人类学家，寻求通过结构化的创新职业发展活动和两个相关的研究项目发展她作为独立研究人员的能力。职业发展活动侧重于人因工程和以人为本的设计。每个拟议的项目都在医院住院和门诊两个环境中采用了一个工作实践研究、设计、实施和评估的周期。工作实践研究方法是文化过程建模，通过观察和访谈确定定向框架(或心理模型)和日常活动，并为特定群体(例如护理单元)描述。数据收集将侧重于在药物规划和管理中使用信息学和其他技术。将特别注意护理中的过渡或移交。将使用一个矩阵来描述安全用药常规与支持或设置安全实践障碍的技术属性之间的关系。PI将与临床、管理和信息学利益相关者合作，设计和实施工作实践或基于信息学的干预措施，以提高用药安全。评估将重点放在利益攸关方的经验和价值评估上，采用响应性/启发性方法。由于项目涉及1)了解背景、2)设计改进的流程和工具、3)实施和4)评价的完整周期，本提案将信息学工具的实施视为组织变革。这项研究推进了信息学中新兴的实施科学领域，旨在应用社会和组织科学、安全科学、工程学等领域的知识、理论和方法来改进信息学实施过程和结果。实施科学应用于健康信息学，可以提高患者的安全性、效率、技术采用和用户满意度。

DESCRIPTION (provided by applicant): The long-term objective of this K99/R00 career development proposal is to improve the interaction between informatics tools and everyday clinical practice. A core premise of this proposal is that medication safety can be improved with informatics technologies that better support the safety-producing routines used by clinicians and patients. The PI is a medical and organizational anthropologist seeking to develop her capacity as an independent researcher through structured, innovative career development activities and two related research projects. Career development activities focus on human factors engineering and human centered design. The proposed projects each employ a cycle of work practice research, design, implementation and evaluation in two settings: hospital inpatient, and outpatient clinic. The work practice research methodology is Cultural Process Modeling, in which orienting frames (or mental models) and routine activities are identified through observation and interviewing and described for a specific group (e.g., a nursing unit). The data collection will focus on the use of informatics and other technologies in medication planning and administration. Special attention will be paid to transitions or handovers in care. A matrix will be used to describe the relationships between safe medication routines and attributes of technology that support or create barriers to safe practice. The PI will collaborate with clinical, management and informatics stakeholders to design and implement a work practice or informatics-based intervention to improve medication safety. Evaluation will focus on stakeholder experiences and value assessment using a Responsive/Illuminative approach. With projects that engage the complete cycle of 1) understanding context, 2) designing improved processes and tools, 3) implementation and 4) evaluation, this proposal views the implementation of informatics tools as organizational change. This research advances the emerging field of Implementation Science in informatics, which seeks to apply knowledge, theory and methods from social and organizational science, safety science, engineering and other fields to improve informatics implementation processes and outcomes. Implementation Science, applied to health informatics, can result in improved patient safety, efficiency, and technology adoption and user satisfaction.