Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Int J Med Inform. 2010 Jun;79(6):430-7. doi: 10.1016/j.ijmedinf.2010.03.001. Epub 2010 Apr 7.
Computerized decision support systems (CDSSs) can be used to improve the implementation of clinical practice guidelines by changing the behaviour of care professionals. While the influence of system characteristics on the effectiveness of CDSSs is studied, little is known about the relation between cognitive, organizational and environmental factors, and CDSSs' effectiveness.
To assess the effect of CDSSs on cognitive, organizational, and environmental factors that hamper guideline implementation.
In-depth, semi-structured interviews with care professionals, on reasons for improved adherence or persistent non-adherence to the prevailing guideline after successful adoption of a CDSS. All remarks regarding guideline implementation were extracted and classified using the conceptual framework from Cabana et al.
Outpatient cardiac rehabilitation clinics.
Care professionals that used the CARDSS decision support system for therapeutic decision making in cardiac rehabilitation.
Twenty-nine rehabilitation nurses and physiotherapists from 21 Dutch clinics were interviewed. CARDSS improved guideline adherence by increasing its users' familiarity with the guidelines' recommendations and decision logic, by overcoming users' inertia to previous practice, and by reducing guideline complexity for example by facilitating calculation and interpretation of data. If the system's recommendations were shared with patients, refusal to participate in therapies reduced. CARDSS never incited users to target barriers related to organizational or environmental constraints.
Our results suggest that computerized decision support can improve guideline implementation by increasing the knowledge of preferred practice, by reducing inertia to previous practice, and by reducing guideline complexity. However, computerized decision support is not effective when organizational or procedural changes are required that users consider to be beyond their tasks and responsibilities.
计算机决策支持系统（CDSS）可用于通过改变医护人员的行为来提高临床实践指南的实施。虽然已经研究了系统特征对 CDSS 有效性的影响，但对于认知、组织和环境因素与 CDSS 有效性之间的关系知之甚少。
评估 CDSS 对阻碍指南实施的认知、组织和环境因素的影响。
对成功采用 CDSS 后，改善对现行指南的依从性或持续不依从性的医护人员进行深入的半结构化访谈，了解他们的原因。使用 Cabana 等人的概念框架提取和分类所有与指南实施相关的意见。
门诊心脏康复诊所。
在心脏康复中使用 CARDSS 决策支持系统进行治疗决策的医护人员。
对 21 家荷兰诊所的 29 名康复护士和物理治疗师进行了访谈。CARDSS 通过增加用户对指南建议和决策逻辑的熟悉程度、克服用户对以往实践的惯性，以及通过简化指南复杂性（例如，方便数据的计算和解释），提高了指南的依从性。如果系统的建议与患者分享，拒绝参加治疗的情况就会减少。CARDSS 从未煽动用户针对与组织或环境限制相关的障碍。
我们的结果表明，计算机化决策支持可以通过提高对首选实践的了解、减少对以往实践的惯性以及降低指南的复杂性来提高指南的实施。然而，当需要用户认为超出其任务和责任范围的组织或程序变更时，计算机化决策支持并不有效。
