Hvitfeldt Helena, Carli Cheryl, Nelson Eugene C, Mortenson Dawne M, Ruppert Birgit A, Lindblad Staffan
Medical Management Centre (MMC) Unit, Department of Learning Informatics, Management & Ethics (LIME), Karolinska Institutet, and Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Qual Manag Health Care. 2009 Oct-Dec;18(4):247-56. doi: 10.1097/QMH.0b013e3181bee32e.
This is a study of 2 clinical feed forward systems (FFSs) situated in different contexts: in the United States, where the system was developed, and in Swedish clinical settings, where it was first adopted. Both systems were identified as clinically successful despite differing contexts, and the objective of this study is to understand what essential properties determined their success.
In our search for essential properties of the FFS, we used acceptance, use, and utility as indicators in questionnaires and interviews of patients and providers. Properties were identified as essential if they enabled reinforcing loops favorable for patients, providers, or both at clinical encounters.
A total of 44 patients participated in each context, along with 13 providers from the United States and 6 providers from the Swedish clinics. In the patient questionnaire, a majority of patients rated their impression of the FFS as excellent to good (United States: 84%, Sweden: 96%, P < .001). Interviews with both patients and providers indicated that the FFS patient overview displaying structured data previous to the clinical encounter is favorable. These essential properties enabled patient involvement through engagement, education, and communication with the provider, who appreciated them as time-saving for managing data and as decision support.
Despite distinctly different contexts and locally adapted content, essential properties that induced successful patient participation and provider support were identified as universal in the FFSs. Thus, further spread of the FFS may be enabled to accomplish patient-centered care and improved clinical information and quality management.
本研究涉及两个处于不同环境的临床前馈系统（FFS）：一个是在美国开发该系统的环境，另一个是瑞典首次采用该系统的临床环境。尽管环境不同，但这两个系统在临床上均被认为是成功的，本研究的目的是了解决定其成功的关键特性。
在寻找FFS的关键特性时，我们将接受度、使用情况和效用作为指标，对患者和医护人员进行问卷调查和访谈。如果某些特性能够在临床接触中形成有利于患者、医护人员或双方的增强回路，那么这些特性就被确定为关键特性。
在每个环境中，共有44名患者参与，还有来自美国的13名医护人员和来自瑞典诊所的6名医护人员。在患者问卷中，大多数患者对FFS的印象评价为优秀或良好（美国：84%，瑞典：96%，P <.001）。对患者和医护人员的访谈表明，在临床接触前展示结构化数据的FFS患者概况是有益的。这些关键特性通过患者与医护人员的参与、教育和沟通，使患者能够参与其中，医护人员认为这些特性节省了管理数据的时间并提供了决策支持。
尽管环境明显不同且内容因地制宜，但在FFS中确定的促成患者成功参与和医护人员支持的关键特性具有普遍性。因此，FFS的进一步推广可能有助于实现以患者为中心的护理，并改善临床信息和质量管理。
