Gulla Joy, Neri Pamela M, Bates David W, Samal Lipika
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Clinical and Quality Analysis, Partners HealthCare System, Wellesley, MA, USA.
Int J Med Inform. 2017 May;101:50-57. doi: 10.1016/j.ijmedinf.2017.01.018. Epub 2017 Feb 4.
Timely referral of patients with CKD has been associated with cost and mortality benefits, but referrals are often done too late in the course of the disease. Clinical decision support (CDS) offers a potential solution, but interventions have failed because they were not designed to support the physician workflow. We sought to identify user requirements for a chronic kidney disease (CKD) CDS system to promote timely referral.
We interviewed primary care physicians (PCPs) to identify data needs for a CKD CDS system that would encourage timely referral and also gathered information about workflow to assess risk factors for progression of CKD. Interviewees were general internists recruited from a network of 14 primary care clinics affiliated with Brigham and Women's Hospital (BWH). We then performed a qualitative analysis to identify user requirements and system attributes for a CKD CDS system.
Of the 12 participants, 25% were women, the mean age was 53 (range 37-82), mean years in clinical practice was 27 (range 11-58). We identified 21 user requirements. Seven of these user requirements were related to support for the referral process workflow, including access to pertinent information and support for longitudinal co-management. Six user requirements were relevant to PCP management of CKD, including management of risk factors for progression, interpretation of biomarkers of CKD severity, and diagnosis of the cause of CKD. Finally, eight user requirements addressed user-centered design of CDS, including the need for actionable information, links to guidelines and reference materials, and visualization of trends.
These 21 user requirements can be used to design an intuitive and usable CDS system with the attributes necessary to promote timely referral.
慢性肾脏病（CKD）患者的及时转诊与成本降低及死亡率下降相关，但转诊往往在疾病进程中过晚进行。临床决策支持（CDS）提供了一种潜在的解决方案，但干预措施却未成功，因为它们并非设计用于支持医生的工作流程。我们试图确定慢性肾脏病CDS系统的用户需求，以促进及时转诊。
我们采访了初级保健医生（PCP），以确定CKD CDS系统中鼓励及时转诊所需的数据需求，并收集了有关工作流程的信息，以评估CKD进展的风险因素。受访者是从与布莱根妇女医院（BWH）相关的14家初级保健诊所网络中招募的普通内科医生。然后，我们进行了定性分析，以确定CKD CDS系统的用户需求和系统属性。
12名参与者中，25%为女性，平均年龄为53岁（范围37 - 82岁），平均临床工作年限为27年（范围11 - 58年）。我们确定了21项用户需求。其中7项用户需求与转诊流程工作流的支持相关，包括获取相关信息和纵向联合管理的支持。6项用户需求与PCP对CKD的管理相关，包括进展风险因素的管理、CKD严重程度生物标志物的解读以及CKD病因的诊断。最后，8项用户需求涉及CDS以用户为中心的设计，包括对可操作信息的需求、与指南和参考资料的链接以及趋势可视化。
这21项用户需求可用于设计一个直观且易用的CDS系统，该系统具备促进及时转诊所需的属性。
