Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA.
Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA.
J Am Med Inform Assoc. 2018 Sep 1;25(9):1175-1182. doi: 10.1093/jamia/ocy069.
Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project.
We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled "Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE)." The mobile application (app), PedsGuide, was developed using evidence-based recommendations created by an interdisciplinary panel. App workflow and content were aligned with clinical benchmarks; app interface was adjusted after usability heuristic review. Usage patterns were measured using Google Analytics.
Overall, 3805 users across the United States downloaded PedsGuide from December 1, 2016, to July 31, 2017, leading to 14 256 use sessions (average 3.75 sessions per user). Users engaged in 60 442 screen views, including 37 424 (61.8%) screen views that displayed content related to the REVISE clinical practice benchmarks, including hospital admission appropriateness (26.8%), length of hospitalization (14.6%), and diagnostic testing recommendations (17.0%). Median user touch depth was 5 [IQR 5].
We observed rapid dissemination and in-depth engagement with PedsGuide, demonstrating feasibility for using smartphone-based ECDS tools within national practice improvement projects.
ECDS tools may prove valuable in future national practice standardization initiatives. Work should next focus on developing robust analytics to determine ECDS tools' impact on medical decision making, clinical practice, and health outcomes.
实施循证实践需要多方面的方法。电子临床决策支持（ECDS）工具可能会鼓励采用循证实践。然而，关于移动 ECDS 工具在儿科中的作用的数据很少。我们的目标是描述一个基于智能手机的 ECDS 工具在国家实践标准化项目中的开发、分布和使用模式。
我们为美国儿科学会的价值在住院儿科网络项目（Value in Inpatient Pediatrics Network）开发了一个名为“减少婴儿败血症评估中的过度变异（Reducing Excessive Variation in the Infant Sepsis Evaluation，REVISE）”的基于智能手机的 ECDS 工具。移动应用程序（app）PedsGuide 是使用由跨学科小组创建的循证建议开发的。应用程序工作流程和内容与临床基准保持一致；在可用性启发式审查后调整了应用程序界面。使用 Google Analytics 测量使用模式。
总体而言，从 2016 年 12 月 1 日至 2017 年 7 月 31 日，美国各地有 3805 名用户下载了 PedsGuide，共进行了 14256 次使用会话（平均每个用户 3.75 次）。用户进行了 60442 次屏幕查看，其中包括 37424 次（61.8%）显示与 REVISE 临床实践基准相关内容的屏幕查看，包括住院适宜性（26.8%）、住院时间（14.6%）和诊断测试建议（17.0%）。中位数用户触摸深度为 5[IQR 5]。
我们观察到 PedsGuide 的快速传播和深入参与，证明了在国家实践改进项目中使用基于智能手机的 ECDS 工具的可行性。
ECDS 工具在未来的国家实践标准化计划中可能具有价值。下一步应集中精力开发强大的分析工具，以确定 ECDS 工具对医疗决策、临床实践和健康结果的影响。
