Melnick Edward R, Hess Erik P, Guo George, Breslin Maggie, Lopez Kevin, Pavlo Anthony J, Abujarad Fuad, Powsner Seth M, Post Lori A
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States.
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States.
J Med Internet Res. 2017 May 19;19(5):e174. doi: 10.2196/jmir.7846.
The Canadian Computed Tomography (CT) Head Rule, a clinical decision rule designed to safely reduce imaging in minor head injury, has been rigorously validated and implemented, and yet expected decreases in CT were unsuccessful. Recent work has identified empathic care as a key component in decreasing CT overuse. Health information technology can hinder the clinician-patient relationship. Patient-centered decision tools to support the clinician-patient relationship are needed to promote evidence-based decisions.
Our objective is to formatively evaluate an electronic tool that not only helps clinicians at the bedside to determine the need for CT use based on the Canadian CT Head Rule but also promotes evidence-based conversations between patients and clinicians regarding patient-specific risk and patients' specific concerns.
User-centered design with practice-based and participatory decision aid development was used to design, develop, and evaluate patient-centered decision support regarding CT use in minor head injury in the emergency department. User experience and user interface (UX/UI) development involved successive iterations with incremental refinement in 4 phases: (1) initial prototype development, (2) usability assessment, (3) field testing, and (4) beta testing. This qualitative approach involved input from patients, emergency care clinicians, health services researchers, designers, and clinical informaticists at every stage.
The Concussion or Brain Bleed app is the product of 16 successive iterative revisions in accordance with UX/UI industry design standards. This useful and usable final product integrates clinical decision support with a patient decision aid. It promotes shared use by emergency clinicians and patients at the point of care within the emergency department context. This tablet computer app facilitates evidence-based conversations regarding CT in minor head injury. It is adaptable to individual clinician practice styles. The resultant tool includes a patient injury evaluator based on the Canadian CT Head Rule and provides patient specific risks using pictographs with natural frequencies and cues for discussion about patient concerns.
This tool was designed to align evidence-based practices about CT in minor head injury patients. It establishes trust, empowers active participation, and addresses patient concerns and uncertainty about their condition. We hypothesize that, when implemented, the Concussion or Brain Bleed app will support-not hinder-the clinician-patient relationship, safely reduce CT use, and improve the patient experience of care.
加拿大计算机断层扫描（CT）头部规则是一项旨在安全减少轻度头部损伤成像检查的临床决策规则，已得到严格验证和实施，但预期的CT检查减少并未成功实现。最近的研究发现，共情护理是减少CT过度使用的关键因素。健康信息技术可能会妨碍医患关系。需要以患者为中心的决策工具来支持医患关系，以促进基于证据的决策。
我们的目标是对一种电子工具进行形成性评估，该工具不仅能帮助床边的临床医生根据加拿大CT头部规则确定是否需要进行CT检查，还能促进患者与临床医生之间就患者特定风险和患者具体担忧进行基于证据的对话。
采用以用户为中心的设计方法，结合基于实践和参与式决策辅助工具开发，来设计、开发和评估急诊科轻度头部损伤患者CT使用的以患者为中心的决策支持。用户体验和用户界面（UX/UI）开发包括4个阶段的连续迭代和逐步完善：（1）初始原型开发，（2）可用性评估，（3）现场测试，（4）测试版测试。这种定性方法在每个阶段都吸收了患者、急诊护理临床医生、卫生服务研究人员、设计师和临床信息学家的意见。
脑震荡或脑出血应用程序是根据UX/UI行业设计标准进行的16次连续迭代修订的产物。这个有用且易用的最终产品将临床决策支持与患者决策辅助工具整合在一起。它促进了急诊科护理现场急诊临床医生和患者的共同使用。这款平板电脑应用程序有助于就轻度头部损伤的CT检查进行基于证据的对话。它能适应个体临床医生的实践风格。最终工具包括一个基于加拿大CT头部规则的患者损伤评估器，并使用带有自然频率的象形图和讨论患者担忧的提示，提供患者特定风险。
该工具旨在使轻度头部损伤患者CT检查的循证实践保持一致。它建立信任，促进积极参与，并解决患者对自身病情的担忧和不确定性。我们假设，当实施时，脑震荡或脑出血应用程序将支持而非妨碍医患关系，安全减少CT使用，并改善患者的护理体验。
