支持住院患者减少用药：计算机化决策支持工具的形成性可用性测试。
Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool.
机构信息
Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre, D17, The University of Sydney, Sydney, NSW, 2006, Australia.
Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, Australia.
出版信息
BMC Med Inform Decis Mak. 2021 Apr 5;21(1):116. doi: 10.1186/s12911-021-01484-z.
BACKGROUND
Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, particularly in hospital settings. Clinical risk assessment tools, like the Drug Burden Index (DBI), can help prioritise patients for medication review and prioritise medications to deprescribe, but are not integrated within routine care. The aim of this study was to conduct formative usability testing of a computerised decision support (CDS) tool, based on DBI, to identify modifications required to the tool prior to trialling in practice.
METHODS
Our CDS tool comprised a DBI MPage in the electronic medical record (clinical workspace) that facilitated review of a patient's DBI and medication list, access to deprescribing resources, and the ability to deprescribe. Two rounds of scenario-based formative usability testing with think-aloud protocol were used. Seventeen end-users participated in the testing, including junior and senior doctors, and pharmacists.
RESULTS
Participants expressed positive views about the DBI CDS tool but testing revealed a number of clear areas for improvement. These primarily related to terminology used (i.e. what is a DBI and how is it calculated?), and consistency of functionality and display. A key finding was that users wanted the CDS tool to look and function in a similar way to other decision support tools in the electronic medical record. Modifications were made to the CDS tool in response to user feedback.
CONCLUSION
Usability testing proved extremely useful for identifying components of our CDS tool that were confusing, difficult to locate or to understand. We recommend usability testing be adopted prior to implementation of any digital health intervention. We hope our revised CDS tool equips clinicians with the knowledge and confidence to consider discontinuation of inappropriate medications in routine care of hospitalised patients. In the next phase of our project, we plan to pilot test the tool in practice to evaluate its uptake and effectiveness in supporting deprescribing in routine hospital care.
背景
尽管越来越多的证据表明，减少用药可以改善临床结果、生活质量，并降低不良药物事件的发生概率，但这一做法并未得到广泛应用，尤其是在医院环境中。临床风险评估工具，如药物负担指数（DBI），可以帮助确定需要进行药物审查的患者优先级，并确定需要减少的药物优先级，但这些工具并未整合到常规护理中。本研究旨在对基于 DBI 的计算机决策支持（CDS）工具进行形成性可用性测试，以确定在实际应用前需要对该工具进行哪些修改。
方法
我们的 CDS 工具包括电子病历（临床工作区）中的 DBI MPage，该 MPage 方便了患者 DBI 和药物清单的审查、获取减药资源以及减药操作。我们采用了两轮基于场景的形成性可用性测试，并使用了出声思维协议。共有 17 名最终用户参与了测试，包括初级和高级医生以及药剂师。
结果
参与者对 DBI CDS 工具表示了积极的看法，但测试也揭示了一些需要改进的明显领域。这些问题主要涉及术语的使用（即什么是 DBI，它是如何计算的？），以及功能和显示的一致性。一个关键发现是，用户希望 CDS 工具在外观和功能上与电子病历中的其他决策支持工具相似。根据用户反馈，对 CDS 工具进行了修改。
结论
可用性测试对于确定我们的 CDS 工具中哪些部分令人困惑、难以定位或难以理解非常有用。我们建议在实施任何数字健康干预措施之前，都要进行可用性测试。我们希望我们修改后的 CDS 工具能够使临床医生具备在常规住院患者护理中考虑停止使用不合适药物的知识和信心。在我们项目的下一阶段，我们计划在实践中试点测试该工具，以评估其在常规医院护理中支持减药的采用率和效果。
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