Beerlage-de Jong Nienke, Wentzel Jobke, Hendrix Ron, van Gemert-Pijnen Lisette
Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands.
Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands; Department of Media, Communication, and Organisation, University of Twente, Enschede, The Netherlands.
Am J Infect Control. 2017 Apr 1;45(4):365-371. doi: 10.1016/j.ajic.2016.12.001. Epub 2017 Jan 12.
Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of CDSSs in ASPs.
A mixed-methods approach was applied, combining scenario-based prototype evaluations (to support verbalization of work processes and out-of-the-box thinking) among 6 medical resident physicians with an online questionnaire (to cross-reference findings of the prototype evaluations) among 54 Dutch physicians.
The prototype evaluations resulted in insight into the end-users and their way of working, as well as their needs and expectations. The online questionnaire that was distributed among a larger group of medical specialists, including lung and infection experts, complemented the findings of the prototype evaluations. It revealed a say/do problem concerning the unrecognized need of support for selecting diagnostic tests.
Low-fidelity prototypes of a technology allow researchers to get to know the end-users, their way of working, and their work context. Involving experts allows technology developers to continuously check the fit between technology and clinical practice. The combination enables the participatory development of technology to successfully support ASPs.
目前用于抗菌药物管理计划（ASP）的临床决策支持系统（CDSS）是由指南或专家驱动的。它们侧重于（临床）内容，而非支持实时工作流程。因此，CDSS在日常实践中无法最佳地支持谨慎的抗菌药物处方。我们的目的是证明为什么以及参与式开发（让最终用户和其他利益相关者参与）如何能促进CDSS在ASP中的成功。
采用混合方法，将6名住院医师基于场景的原型评估（以支持工作流程的语言化和跳出框框的思考）与54名荷兰医生的在线问卷调查（以交叉参考原型评估的结果）相结合。
原型评估使我们深入了解了最终用户及其工作方式，以及他们的需求和期望。在包括肺部和感染专家在内的更大规模医学专家群体中分发的在线问卷补充了原型评估的结果。它揭示了一个关于选择诊断测试时未被认识到的支持需求的“说/做”问题。
技术的低保真原型使研究人员能够了解最终用户、他们的工作方式以及工作背景。让专家参与使技术开发人员能够不断检查技术与临床实践之间的契合度。这种结合能够使技术的参与式开发成功支持ASP。
