Enterprise Information Services, Cedars-Sinai Medical Center , 8700 Beverly Blvd, Los Angeles, CA 90048 (JMP, XL, PS).
Appl Clin Inform. 2013 Dec 4;4(4):569-82. doi: 10.4338/ACI-2013-04-RA-0021. eCollection 2013.
In determining whether clinical decision support (CDS) should be interruptive or non-interruptive, CDS designers need more guidance to balance the potential for interruptive CDS to overburden clinicians and the potential for non-interruptive CDS to be overlooked by clinicians.
(1)To compare performance achieved by clinicians using interruptive CDS versus using similar, non-interruptive CDS. (2)To compare performance achieved using non-interruptive CDS among clinicians exposed to interruptive CDS versus clinicians not exposed to interruptive CDS.
We studied 42 emergency medicine physicians working in a large hospital where an interruptive CDS to help identify patients requiring contact isolation was replaced by a similar, but non-interruptive CDS. The first primary outcome was the change in sensitivity in identifying these patients associated with the conversion from an interruptive to a non-interruptive CDS. The second primary outcome was the difference in sensitivities yielded by the non-interruptive CDS when used by providers who had and who had not been exposed to the interruptive CDS. The reference standard was an epidemiologist-designed, structured, objective assessment.
In identifying patients needing contact isolation, the interruptive CDS-physician dyad had sensitivity of 24% (95% CI: 17%-32%), versus sensitivity of 14% (95% CI: 9%-21%) for the non-interruptive CDS-physician dyad (p = 0.04). Users of the non-interruptive CDS with prior exposure to the interruptive CDS were more sensitive than those without exposure (14% [95% CI: 9%-21%] versus 7% [95% CI: 3%-13%], p = 0.05).
As with all observational studies, we cannot confirm that our analysis controlled for every important difference between time periods and physician groups.
Interruptive CDS affected clinicians more than non-interruptive CDS. Designers of CDS might explicitly weigh the benefits of interruptive CDS versus its associated increased clinician burden. Further research should study longer term effects of clinician exposure to interruptive CDS, including whether it may improve clinician performance when using a similar, subsequent non-interruptive CDS.
在确定临床决策支持（CDS）应该是中断式还是非中断式时，CDS 设计人员需要更多的指导来平衡中断式 CDS 可能会给临床医生带来过重负担的风险，以及非中断式 CDS 可能会被临床医生忽视的风险。
（1）比较临床医生使用中断式 CDS 和类似的非中断式 CDS 时的表现。（2）比较在接触隔离的患者识别方面，接触过中断式 CDS 的临床医生与未接触过中断式 CDS 的临床医生使用非中断式 CDS 时的表现。
我们研究了在一家大型医院工作的 42 名急诊医师，该医院的一种中断式 CDS 用于帮助识别需要接触隔离的患者，后来被一种类似的、但非中断式 CDS 所取代。第一个主要结果是，与从中断式 CDS 转换为非中断式 CDS 相关的识别这些患者的敏感性的变化。第二个主要结果是，在接触过中断式 CDS 和未接触过中断式 CDS 的提供者使用非中断式 CDS 时，其敏感性的差异。参考标准是由流行病学家设计的、结构化的、客观的评估。
在识别需要接触隔离的患者时，中断式 CDS-医生对的敏感性为 24%（95%CI：17%-32%），而非中断式 CDS-医生对的敏感性为 14%（95%CI：9%-21%）（p=0.04）。接触过中断式 CDS 的非中断式 CDS 用户比未接触过的用户更敏感（14%[95%CI：9%-21%]比 7%[95%CI：3%-13%]，p=0.05）。
与所有观察性研究一样，我们不能确定我们的分析是否控制了不同时期和不同医生群体之间的每一个重要差异。
中断式 CDS 对临床医生的影响大于非中断式 CDS。CDS 的设计者可能会明确权衡中断式 CDS 的优势与其相关的临床医生负担增加。进一步的研究应该研究临床医生接触中断式 CDS 的长期影响，包括它是否会在使用类似的后续非中断式 CDS 时提高临床医生的表现。
