Eiring Øystein, Nytrøen Kari, Kienlin Simone, Khodambashi Soudabeh, Nylenna Magne
Faculty of Medicine, University of Oslo, Postbox 1072, Blindern, N-0316, Oslo, Norway.
Norwegian Institute of Public Health, Postbox 4404, Nydalen, N-0403, Oslo, Norway.
BMC Med Inform Decis Mak. 2017 Jul 10;17(1):102. doi: 10.1186/s12911-017-0481-x.
People with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies.
Based on the frameworks of shared decision-making, multi-criteria decision analysis, and single-subject research design, we interviewed potential users, reviewed research and current approaches, and created a first version using a rapid prototyping framework. We then iteratively improved and expanded the service based on formative usability testing with patients, healthcare providers, and laypeople from Norway, the UK, and Ukraine. The evidence-based health-optimization system was developed using systematic methods. The System Usability Scale and a questionnaire were administered in formative and summative tests. A comparison of the system to current standards for clinical practice guidelines and patient decision aids was performed.
Seventy-eight potential users identified 82 issues. Driven by user feedback, the limited first version was developed into a more comprehensive system. The current version encompasses 21 integrated core features, supporting 6 health-optimization strategies. One crucial feature enables patients and clinicians to explore the likely value of treatments based on mathematical integration of self-reported and research data and the patient's preferences. The mean ± SD (median) system usability score of the patient-oriented subsystem was 71 ± 18 (73). The mean ± SD (median) system usability score in the summative usability testing was 78 ± 18 (75), well above the norm score of 68. Feedback from the questionnaire was generally positive. Eighteen out of 23 components in the system are not required in international standards for patient decision aids and clinical practice guidelines.
We have developed the first evidence-based health-optimization system enabling patients, clinicians, and caregivers to collaborate in optimizing the patient's health on a shared platform. User tests indicate that the feasibility of the system is acceptable.
双相情感障碍患者常常健康状况不佳，预期寿命大幅缩短。治疗效果欠佳的情况很常见，包括缺乏有效药物、过度治疗以及不遵守医疗干预措施和生活方式建议。电子健康和移动健康应用程序有助于患者优化治疗，但往往存在概念和技术上的缺陷。这项工作的目的是开发并测试一个针对治疗效果欠佳问题的系统的可用性，并将该服务与其他类型和策略进行比较。
基于共同决策、多标准决策分析和单受试者研究设计的框架，我们采访了潜在用户，回顾了研究和当前方法，并使用快速原型框架创建了第一个版本。然后，我们根据来自挪威、英国和乌克兰的患者、医疗保健提供者和普通民众的形成性可用性测试，对该服务进行了迭代改进和扩展。基于系统方法开发了循证健康优化系统。在形成性和总结性测试中使用了系统可用性量表和一份问卷。将该系统与临床实践指南和患者决策辅助工具的当前标准进行了比较。
78名潜在用户识别出82个问题。在用户反馈的推动下，最初有限的版本发展成为一个更全面的系统。当前版本包含21个集成核心功能，支持6种健康优化策略。一个关键功能使患者和临床医生能够根据自我报告数据、研究数据以及患者偏好的数学整合，探索治疗的可能价值。面向患者的子系统的系统可用性平均得分±标准差（中位数）为71±18（73）。总结性可用性测试中的系统可用性平均得分±标准差（中位数）为78±18（75），远高于68的标准得分。问卷反馈总体上是积极的。该系统23个组件中有18个在患者决策辅助工具和临床实践指南的国际标准中并不需要。
我们开发了首个循证健康优化系统，使患者、临床医生和护理人员能够在一个共享平台上合作优化患者的健康。用户测试表明该系统的可行性是可接受的。
