Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States.
OCHIN Inc., Portland, Oregon, United States.
Appl Clin Inform. 2023 May;14(3):594-599. doi: 10.1055/s-0043-1769913. Epub 2023 Aug 2.
Clinical decision support (CDS) tools that provide point-of-care reminders of patients' care needs may improve rates of guideline-concordant cervical cancer screening. However, uptake of such electronic health record (EHR)-based tools in primary care practices is often low. This study describes the frequency of factors associated with, and barriers and facilitators to adoption of a cervical cancer screening CDS tool (CC-tool) implemented in a network of community health centers.
This mixed-methods sequential explanatory study reports on CC-tool use among 480 community-based clinics, located across 18 states. Adoption of the CC-tool was measured as any instance of tool use (i.e., entry of cervical cancer screening results or follow-up plan) and as monthly tool use rates from November 1, 2018 (tool release date) to December 31, 2020. Adjusted odds and rates of tool use were evaluated using logistic and negative-binomial regression. Feedback from nine clinic staff representing six clinics during user-centered design sessions and semi-structured interviews with eight clinic staff from two additional clinics were conducted to assess barriers and facilitators to tool adoption.
The CC-tool was used ≥1 time in 41% of study clinics during the analysis period. Clinics that ever used the tool and those with greater monthly tool use had, on average, more encounters, more patients from households at >138% federal poverty level, fewer pediatric encounters, higher up-to-date cervical cancer screening rates, and higher rates of abnormal cervical cancer screening results. Qualitative data indicated barriers to tool adoption, including lack of knowledge of the tool's existence, understanding of its functionalities, and training on its use.
Without effective systems for informing users about new EHR functions, new or updated EHR tools are unlikely to be widely adopted, reducing their potential to improve health care quality and outcomes.
提供患者护理需求即时提醒的临床决策支持（CDS）工具可能会提高符合指南的宫颈癌筛查率。然而，此类基于电子健康记录（EHR）的工具在初级保健实践中的采用率往往较低。本研究描述了在社区卫生中心网络中实施的宫颈癌筛查 CDS 工具（CC 工具）的采用相关因素的频率，以及采用的障碍和促进因素。
这项混合方法的序贯解释性研究报告了在 18 个州的 480 个社区诊所中 CC 工具的使用情况。采用 CC 工具的定义为任何一次工具使用（即输入宫颈癌筛查结果或随访计划），以及从 2018 年 11 月 1 日（工具发布日期）到 2020 年 12 月 31 日的每月工具使用率。使用逻辑回归和负二项回归评估工具使用的调整后比值和率。在用户为中心的设计会议期间，来自 9 个诊所的工作人员提供了反馈，在另外 2 个诊所的 8 名工作人员进行了半结构化访谈，以评估采用工具的障碍和促进因素。
在分析期间，41%的研究诊所至少使用过一次 CC 工具。曾使用过该工具的诊所和每月使用工具次数较多的诊所，平均而言，其就诊人次更多，来自联邦贫困线以上 138%的家庭的患者更多，儿科就诊人次更少，最新的宫颈癌筛查率更高，以及异常宫颈癌筛查结果的比例更高。定性数据表明，采用工具的障碍包括缺乏对工具存在的了解、对其功能的理解以及对其使用的培训。
如果没有有效的系统向用户告知新的 EHR 功能，那么新的或更新的 EHR 工具不太可能被广泛采用，从而降低了它们改善医疗保健质量和结果的潜力。
