Patterson Emily S, Nguyen Anh D, Halloran James P, Asch Steven M
VA Getting at Patient Safety Center, Cincinatti VAMC, The Ohio State University, Columbus, OH 43210, USA.
J Am Med Inform Assoc. 2004 Jan-Feb;11(1):50-9. doi: 10.1197/jamia.M1364. Epub 2003 Oct 5.
Substantial variations in adherence to guidelines for human immunodeficiency virus (HIV) care have been documented. To evaluate their effectiveness in improving quality of care, ten computerized clinical reminders (CRs) were implemented at two pilot and eight study sites. The aim of this study was to identify human factors barriers to the use of these CRs.
Observational study was conducted of CRs in use at eight outpatient clinics for one day each and semistructured interviews were conducted with physicians, pharmacists, nurses, and case managers.
Detailed handwritten field notes of interpretations and actions using the CRs and responses to interview questions were used for measurement.
Barriers present at more than one site were (1) workload during patient visits (8 of 8 sites), (2) time to document when a CR was not clinically relevant (8 of 8 sites), (3) inapplicability of the CR due to context-specific reasons (9 of 26 patients), (4) limited training on how to use the CR software for rotating staff (5 of 8 sites) and permanent staff (3 of 8 sites), (5) perceived reduction of quality of provider-patient interaction (3 of 23 permanent staff), and (6) the decision to use paper forms to enable review of resident physician orders prior to order entry (2 of 8 sites).
Six human factors barriers to the use of HIV CRs were identified. Reducing these barriers has the potential to increase use of the CRs and thereby improve the quality of HIV care.
已记录到在人类免疫缺陷病毒（HIV）护理指南的遵循方面存在显著差异。为评估其在改善护理质量方面的有效性，在两个试点和八个研究地点实施了十条计算机化临床提醒（CR）。本研究的目的是确定使用这些CR的人为因素障碍。
对八个门诊诊所使用的CR进行了为期一天的观察性研究，并对医生、药剂师、护士和病例管理人员进行了半结构化访谈。
使用对CR的解读和操作的详细手写现场记录以及对访谈问题的回答进行测量。
多个地点存在的障碍包括：（1）患者就诊期间的工作量（8个地点中的8个）；（2）记录CR与临床无关情况的时间（8个地点中的8个）；（3）由于特定背景原因CR不适用（26名患者中的9名）；（4）对轮岗工作人员（8个地点中的5个）和长期工作人员（8个地点中的3个）使用CR软件的培训有限；（5）认为医患互动质量下降（23名长期工作人员中的3名）；（6）决定使用纸质表格以便在录入医嘱前审查住院医师的医嘱（8个地点中的2个）。
确定了使用HIV CR的六个人为因素障碍。减少这些障碍有可能增加CR的使用，从而提高HIV护理质量。
