What do healthcare professionals need to turn risk models for type 2 diabetes into usable computerized clinical decision support systems? Lessons learned from the MOSAIC project
What do healthcare professionals need to turn risk models for type 2 diabetes into usable computerized clinical decision support systems? Lessons learned from the MOSAIC project
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DOI：
10.1186/s12911-019-0887-8
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发表时间：
2019-08-16
影响因子：
3.5
通讯作者：
Teresa Arredondo, Maria
中科院分区：
文献类型：
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作者：
Fico, Giuseppe;Hernanzez, Liss;Teresa Arredondo, Maria
了解用户需求、系统要求和组织条件，以成功设计和采用基于计算机化风险模型的2型糖尿病（T2 D）护理临床决策支持系统。方法在MOSAIC项目中采用整体和循证的CEHRES路线图，通过参与式发展方法，有说服力的设计技术和商业建模来创建电子健康解决方案，以确定多学科方法的顺序，分为三个阶段，用户需求，实施和评估。本研究为质性研究，共90名被试，每轮实验约5 - 17人参与。结果T2 D发病的预测模型建立在临床研究基础上，而T2 D护理则来自医疗注册。因此，定义了两组DSS：第一组是T2 D筛查，引入了一种新的常规;第二组是T2 D护理，DSS可以支持人群水平的管理人员和个人水平的日常从业人员。在用户需求阶段，人群水平的T2 D筛查和T2 D护理解决方案具有相似的优先级，因为两者都涉及风险分层。T2 D筛查和T2 D护理解决方案的最终用户在个人层面上优先考虑易用性和满意度，而管理人员更喜欢随时随地可用的工具。在实施阶段，为T2 D筛查定义了三个用例，使工具适应不同的设置和信息粒度。围绕解决方案T2 D人群护理和T2 D个人护理定义了两个用例，用于初级或二级护理。合适的过滤选项配备了“有吸引力的”视觉分析，以将最终用户的注意力集中在特定的参数和事件上。在评估阶段，良好的用户体验水平与糟糕的可用性水平表明，T2 D筛查的最终用户感知到了潜力，但他们担心复杂性。T2 D护理人群和T2 D护理个体的可用性和用户体验均高于可接受阈值。结论通过使用整体方法，我们已经能够了解用户的需求，行为和互动，并在有效的决策支持系统的定义中提供新的见解，以处理T2 D护理的复杂性。
Background To understand user needs, system requirements and organizational conditions towards successful design and adoption of Clinical Decision Support Systems for Type 2 Diabetes (T2D) care built on top of computerized risk models. Methods The holistic and evidence-based CEHRES Roadmap, used to create eHealth solutions through participatory development approach, persuasive design techniques and business modelling, was adopted in the MOSAIC project to define the sequence of multidisciplinary methods organized in three phases, user needs, implementation and evaluation. The research was qualitative, the total number of participants was ninety, about five-seventeen involved in each round of experiment. Results Prediction models for the onset of T2D are built on clinical studies, while for T2D care are derived from healthcare registries. Accordingly, two set of DSSs were defined: the first, T2D Screening, introduces a novel routine; in the second case, T2D Care, DSSs can support managers at population level, and daily practitioners at individual level. In the user needs phase, T2D Screening and solution T2D Care at population level share similar priorities, as both deal with risk-stratification. End-users of T2D Screening and solution T2D Care at individual level prioritize easiness of use and satisfaction, while managers prefer the tools to be available every time and everywhere. In the implementation phase, three Use Cases were defined for T2D Screening, adapting the tool to different settings and granularity of information. Two Use Cases were defined around solutions T2D Care at population and T2D Care at individual, to be used in primary or secondary care. Suitable filtering options were equipped with "attractive" visual analytics to focus the attention of end-users on specific parameters and events. In the evaluation phase, good levels of user experience versus bad level of usability suggest that end-users of T2D Screening perceived the potential, but they are worried about complexity. Usability and user experience were above acceptable thresholds for T2D Care at population and T2D Care at individual. Conclusions By using a holistic approach, we have been able to understand user needs, behaviours and interactions and give new insights in the definition of effective Decision Support Systems to deal with the complexity of T2D care.