Desai Arti D, Wang Grace, Wignall Julia, Kinard Dylan, Singh Vidhi, Adams Sherri, Pratt Wanda
Department of Pediatrics, University of Washington, Seattle, Washington, USA.
Seattle Children's Research Institute, Seattle, Washington, USA.
J Am Med Inform Assoc. 2020 Dec 9;27(12):1860-1870. doi: 10.1093/jamia/ocaa193.
To determine the content priorities and design preferences for a longitudinal care plan (LCP) among caregivers and healthcare providers who care for children with medical complexity (CMC) in acute care settings.
We conducted iterative one-on-one design sessions with CMC caregivers (ie, parents/legal guardians) and providers from 5 groups: complex care, primary care, subspecialists, emergency care, and care coordinators. Audio-recorded sessions included content categorization activities, drawing exercises, and scenario-based testing of an electronic LCP prototype. We applied inductive content analysis of session materials to elicit content priorities and design preferences between sessions. Analysis informed iterative prototype revisions.
We conducted 30 design sessions (10 with caregivers, 20 with providers). Caregivers expressed high within-group variability in their content priorities compared to provider groups. Emergency providers had the most unique content priorities among clinicians. We identified 6 key design preferences: a familiar yet customizable layout, a problem-based organization schema, linked content between sections, a table layout for most sections, a balance between unstructured and structured data fields, and use of family-centered terminology.
Findings from this study will inform enhancements of electronic health record-embedded LCPs and the development of new LCP tools and applications. The design preferences we identified provide a framework for optimizing integration of family and provider content priorities while maintaining a user-tailored experience.
Health information platforms that incorporate these design preferences into electronic LCPs will help meet the information needs of caregivers and providers caring for CMC in acute care settings.
确定在急性护理环境中照顾患有复杂疾病儿童（CMC）的护理人员和医疗服务提供者对纵向护理计划（LCP）的内容优先级和设计偏好。
我们与CMC护理人员（即父母/法定监护人）以及来自5个组别的医疗服务提供者进行了一对一的迭代设计会议，这5个组别分别是：复杂护理、初级护理、专科专家、急诊护理和护理协调员。录音会议包括内容分类活动、绘图练习以及基于场景的电子LCP原型测试。我们对会议材料进行归纳性内容分析，以找出各次会议之间的内容优先级和设计偏好。分析结果为原型的迭代修订提供了依据。
我们开展了30次设计会议（10次与护理人员，20次与医疗服务提供者）。与医疗服务提供者组相比，护理人员在内容优先级方面表现出较高的组内变异性。急诊医疗服务提供者在临床医生中具有最独特的内容优先级。我们确定了6个关键设计偏好：熟悉但可定制的布局、基于问题的组织架构、各部分之间的关联内容、大多数部分采用表格布局、非结构化和结构化数据字段之间的平衡以及使用以家庭为中心的术语。
本研究的结果将为改进嵌入电子健康记录的LCP以及开发新的LCP工具和应用提供参考。我们确定的设计偏好提供了一个框架，用于优化家庭和医疗服务提供者内容优先级的整合，同时保持用户定制的体验。
将这些设计偏好纳入电子LCP的健康信息平台将有助于满足在急性护理环境中照顾CMC的护理人员和医疗服务提供者的信息需求。
