临床医生使用和实施一款旨在预测早产风险和辅助临床决策的医疗手机应用程序（QUiPP V2）的体验。
Clinicians' experiences of using and implementing a medical mobile phone app (QUiPP V2) designed to predict the risk of preterm birth and aid clinical decision making.
机构信息
Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK.
出版信息
BMC Med Inform Decis Mak. 2021 Nov 18;21(1):320. doi: 10.1186/s12911-021-01681-w.
BACKGROUND
As the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making as it produces individualised risks of delivery within relevant timeframes. Recent evidence has highlighted that clinicians would welcome a decision-support tool that accurately predicts preterm birth.
METHODS
Qualitative interviews were undertaken as part of the EQUIPTT study (The Evaluation of the QUiPP app for Triage and Transfer) (REC: 17/LO/1802) which aimed to evaluate the impact of the QUiPP app on management of TPTL. Individual semi-structured telephone interviews were used to explore clinicians' (obstetricians' and midwives') experiences of using the QUiPP app and how it was implemented at their hospital sites. Thematic analysis was chosen to explore the meaning of the data, through a framework approach.
RESULTS
Nineteen participants from 10 hospital sites in England took part. Data analysis revealed three overarching themes which were: 'experience of using the app', 'how QUiPP risk changes practice' and 'successfully adopting QUiPP: context is everything'. With these final themes we appeared to have achieved our aim of exploring the clinicians' experiences of using and implementing the QUiPP app.
CONCLUSION
This study explored different clinician's experiences of implementing the app. The organizational and cultural context at different sites appeared to have a large impact on how well the QUiPP app was implemented. Future work needs to be undertaken to understand how best to embed the intervention within different settings. This will inform scale up of QUiPP app use across the UK and ensure that clinicians have access to this free, easy-to-use tool which can positively aid clinical decision making when caring for women in TPTL.
CLINICAL TRIAL REGISTRY AND REGISTRATION NUMBER
ISRCTN 17846337, registered 08th January 2018, https://doi.org/10.1186/ISRCTN17846337 .
背景
由于绝大多数出现早产威胁的女性都不会早产，因此临床医生需要权衡过度医疗大多数女性的风险，以及对那些出院回家的女性潜在早产的风险。QUiPP 应用程序是一个免费的、经过验证的应用程序，可以支持临床决策，因为它可以在相关时间范围内产生分娩的个体化风险。最近的证据表明，临床医生希望有一种决策支持工具能够准确预测早产。
方法
作为 EQUIPTT 研究（QUiPP 应用程序用于分诊和转移的评估）（REC：17/LO/1802）的一部分，进行了定性访谈，该研究旨在评估 QUiPP 应用程序对早产威胁管理的影响。使用个别半结构化电话访谈来探讨临床医生（产科医生和助产士）使用 QUiPP 应用程序的经验，以及它在他们医院现场的实施情况。选择主题分析来通过框架方法探索数据的含义。
结果
来自英格兰 10 家医院的 19 名参与者参加了研究。数据分析揭示了三个总体主题，即“使用应用程序的经验”、“QUiPP 风险如何改变实践”和“成功采用 QUiPP：背景至关重要”。通过这些最终主题，我们似乎已经实现了探索临床医生使用和实施 QUiPP 应用程序的经验的目标。
结论
本研究探讨了不同临床医生实施应用程序的经验。不同地点的组织和文化背景似乎对 QUiPP 应用程序的实施效果有很大影响。未来需要开展工作，了解如何在不同环境中最好地嵌入干预措施。这将为 QUiPP 应用程序在英国的广泛使用提供信息，并确保临床医生能够获得这种免费、易于使用的工具，当照顾早产威胁的女性时，该工具可以积极辅助临床决策。
临床试验注册号和注册日期
ISRCTN 17846337，于 2018 年 1 月 8 日注册，https://doi.org/10.1186/ISRCTN17846337。
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