Cambridge Centre for Health Services Research (CCHSR), Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
Implement Sci. 2017 Sep 15;12(1):113. doi: 10.1186/s13012-017-0644-2.
BACKGROUND: Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. METHODS: Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation. RESULTS: We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as "positions." The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians' perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians' reasoning and fostering organizational learning. CONCLUSIONS: Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians' attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.
背景：先进的计算机决策支持系统（CDSS）帮助临床医生做出决策，根据最新的科学证据生成建议。尽管这项技术有可能提高患者护理的质量，但仅仅提供它并不能保证被采用：即使 CDSS 可用，临床医生也经常不采纳其建议。本研究调查了不同卫生专业人员在不同 CDSS 采用阶段的医院中对基于证据的 CDSS 的采用所感知到的障碍和促进因素。
方法：作为 CDSS 系列随机对照试验的一部分进行的定性研究。样本包括两家正在使用 CDSS 的医院和两家计划未来采用 CDSS 的医院。我们采访了医生、护士、信息技术人员和董事会成员（n=30）。我们使用恒定比较方法开发了一个指导实施的框架。
结果：我们确定了六种体验和对 CDSS 的态度簇，我们将其标记为“立场”。这六个立场代表了对 CDSS 控制程度的梯度（从低到高），并具有不同类型的 CDSS 采用障碍。最严重的障碍（在前几个立场中普遍存在）包括临床医生认为 CDSS 可能会降低他们的专业自主权，或者在医疗法律争议中可能会对他们不利。朝着最后几个立场前进，这些障碍被与技术接口相关的技术和可用性问题所取代。当所有障碍都被克服时，CDSS 被视为服务于其用户的工作工具，整合了临床医生的推理并促进了组织学习。
结论：CDSS 使用的障碍和促进因素是动态的，可能在其引入临床环境之前就存在；提供一份不论具体实施阶段和背景的静态障碍和促进因素清单可能不足以或无益于促进采用。在探索医院采用 CDSS 的准备情况时，需要考虑临床医生对科学证据和指南的态度、跨学科关系的质量以及透明和负责的组织风气等因素。
Nat Rev Gastroenterol Hepatol. 2025-8-22
J Am Coll Emerg Physicians Open. 2025-6-5
AMIA Annu Symp Proc. 2025-5-22
Npj Ment Health Res. 2025-5-10
J Med Internet Res. 2017-7-7
BMC Med Inform Decis Mak. 2015-10-12
Implement Sci. 2015-4-21
BMC Med Inform Decis Mak. 2015-2-7
Zotero 插件