Global Entrepreneurship Research and Innovation Center (GERIC), Universiti Malaysia Kelantan, Kelantan, Malaysia.
BMC Med Inform Decis Mak. 2012 Dec 5;12:142. doi: 10.1186/1472-6947-12-142.
Computer-based clinical decision support systems (CDSS) are regarded as a key element to enhance decision-making in a healthcare environment to improve the quality of medical care delivery. The concern of having new CDSS unused is still one of the biggest issues in developing countries for the developers and implementers of clinical IT systems. The main objectives of this study are to determine whether (1) the physician's perceived professional autonomy, (2) involvement in the decision to implement CDSS and (3) the belief that CDSS will improve job performance increase the intention to adopt CDSS. Four hypotheses were formulated and tested.
A questionnaire-based survey conducted between July 2010 and December 2010. The study was conducted in seven public and five private hospitals in Kuala Lumpur, Malaysia. Before contacting the hospitals, necessary permission was obtained from the Ministry of Health, Malaysia and the questionnaire was vetted by the ethics committee of the ministry. Physicians working in 12 hospitals from 10 different specialties participated in the study. The sampling method used was stratified random sampling and the physicians were stratified based on the specialty. A total of 450 physicians were selected using a random number generator. Each of these physicians was given a questionnaire and out of 450 questionnaires, 335 (response rate--74%) were returned and 309 (69%) were deemed usable.
The hypotheses were tested using Structural Equation Modeling (SEM). Salient results are: (1) Physicians' perceived threat to professional autonomy lowers the intention to use CDSS (p < 0.01); (2) Physicians involvement in the planning, design and implementation increases their intention to use CDSS (p < 0.01); (3) Physicians belief that the new CDSS will improve his/her job performance increases their intention to use CDSS (p < 0.01).
The proposed model with the three main constructs (physician's professional characteristic, involvement and belief) explains 47% of the variance in the intention to use CDSS. This is significantly higher than the models addressed so far. The results will have a major impact in implementing CDSS in developing countries.
计算机临床决策支持系统（CDSS）被认为是提高医疗环境下决策质量以改善医疗服务提供的关键要素。对于临床 IT 系统的开发者和实施者来说，新的 CDSS 未被使用仍然是发展中国家面临的最大问题之一。本研究的主要目的是确定（1）医生感知的职业自主性，（2）参与 CDSS 实施决策以及（3）相信 CDSS 将提高工作绩效是否会增加采用 CDSS 的意愿。提出并检验了四个假设。
2010 年 7 月至 12 月进行了基于问卷调查的研究。该研究在马来西亚吉隆坡的七家公立医院和五家私立医院进行。在联系医院之前，已从马来西亚卫生部获得了必要的许可，并且该问卷已通过该部伦理委员会的审查。来自 10 个不同专业的 12 家医院的医生参加了这项研究。使用分层随机抽样方法，根据专业对医生进行分层。使用随机数生成器选择了 450 名医生。向每位医生发放了一份问卷，在 450 份问卷中，有 335 份（回应率为 74％）被退回，其中 309 份（69％）被认为可用。
使用结构方程模型（SEM）检验了假设。主要结果是：（1）医生感知的对职业自主性的威胁降低了使用 CDSS 的意愿（p <0.01）；（2）医生参与规划，设计和实施会增加其使用 CDSS 的意愿（p <0.01）；（3）医生相信新的 CDSS 将提高其工作绩效，这增加了他们使用 CDSS 的意愿（p <0.01）。
具有三个主要构念（医生的职业特征，参与和信念）的建议模型解释了使用 CDSS 的意图的 47％的差异。这明显高于迄今为止解决的模型。该结果将对发展中国家实施 CDSS 产生重大影响。
