Nudging Provider Adoption of Clinical Decision Support

摘要 长期的职业目标是成为一名领先的独立研究人员，改变健康 信息技术，Safiya I.Richardson，医学博士，公共卫生硕士，提出了一个有指导的研究项目和具体的 职业发展计划，这将使她准备好使用行为科学来制定有效的临床决策 支持(CDS)。通常的临床实践和基于证据的临床实践之间的差异导致了三分之一的 医院死亡和浪费估计每年有3800亿美元。计算机化的CDS有可能 通过在决策点向医疗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在护理方面的适度改善明显受限于持续较低的水平 提供商采用率，估计为10%。本项目运用行为学理论和行为学的关键原理 说明和解决提供商采用CDS的障碍的经济学。 理查森博士将使用能力、机会、动机、行为(COM-B)框架 供应商采用肺栓塞风险预测CDS工具的障碍。使用CDS评估Pre 计算机断层扫描肺血管造影术前的测试概率降低25% 漏掉了肺栓子。提供商的常规使用将减少600,000次扫描，减少84,000例 在美国，造影剂诱导的肾病和预防3000种恶性肿瘤以及2000例癌症死亡 美国每年都有。此培训应用程序的总体目标是开发和评估 提供商采用包含NUDGE的新工具的可行性和初步效果 旨在解决工具使用方面的障碍。轻推是行为科学的应用 经济学家，定义为积极的强化和间接的建议，对 做决定。 该提案旨在：1)开发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)评估新工具的可行性和 在试点试验中，与当前工具相比，提供商采用新工具的初步效果。这 项目使用多阶段混合方法框架。它是第一个评估轻推对提供商的影响的公司 采用CDS。这项研究得到职业发展活动的补充，包括#年的正式培训 健康信息学、行为科学、混合方法和临床试验设计。在An的指导下 经验丰富的指导团队，建议的研究和培训活动将导致发展a 竞争性R01赠款申请，以评估新工具在改善健康结果方面的有效性。

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.