Mazurenko Olena, McCord Emma, McDonnell Cara, Apathy Nate C, Sanner Lindsey, Adams Meredith C B, Mamlin Burke W, Vest Joshua R, Hurley Robert W, Harle Christopher A
Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA.
Clem McDonald Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.
JAMIA Open. 2023 Aug 9;6(3):ooad063. doi: 10.1093/jamiaopen/ooad063. eCollection 2023 Oct.
To evaluate primary care provider (PCP) experiences using a clinical decision support (CDS) tool over 16 months following a user-centered design process and implementation.
We conducted a qualitative evaluation of the Chronic Pain OneSheet (OneSheet), a chronic pain CDS tool. OneSheet provides pain- and opioid-related risks, benefits, and treatment information for patients with chronic pain to PCPs. Using the 5 Rights of CDS framework, we conducted and analyzed semi-structured interviews with 19 PCPs across 2 academic health systems.
PCPs stated that OneSheet mostly contained the right information required to treat patients with chronic pain and was correctly located in the electronic health record. PCPs used OneSheet for distinct subgroups of patients with chronic pain, including patients prescribed opioids, with poorly controlled pain, or new to a provider or clinic. PCPs reported variable workflow integration and selective use of certain OneSheet features driven by their preferences and patient population. PCPs recommended broadening OneSheet access to clinical staff and patients for data entry to address clinician time constraints.
Differences in patient subpopulations and workflow preferences had an outsized effect on CDS tool use even when the CDS contained the right information identified in a user-centered design process.
To increase adoption and use, CDS design and implementation processes may benefit from increased tailoring that accommodates variation and dynamics among patients, visits, and providers.
评估初级保健提供者（PCP）在以用户为中心的设计过程和实施后的16个月内使用临床决策支持（CDS）工具的体验。
我们对慢性疼痛单页（单页）这一慢性疼痛CDS工具进行了定性评估。单页为初级保健提供者提供慢性疼痛患者的疼痛及阿片类药物相关风险、益处和治疗信息。我们使用CDS框架的五项权利，对两个学术健康系统中的19名初级保健提供者进行并分析了半结构化访谈。
初级保健提供者表示，单页大多包含治疗慢性疼痛患者所需的正确信息，且在电子健康记录中的位置正确。初级保健提供者将单页用于慢性疼痛患者的不同亚组，包括开具阿片类药物的患者、疼痛控制不佳的患者，或新到提供者或诊所的患者。初级保健提供者报告了工作流程整合的差异以及受其偏好和患者群体驱动对单页某些功能的选择性使用。初级保健提供者建议扩大临床工作人员和患者对单页的访问权限以进行数据录入，以解决临床医生的时间限制。
即使CDS包含以用户为中心的设计过程中确定的正确信息，患者亚群体和工作流程偏好的差异对CDS工具的使用仍有巨大影响。
为了提高采用率和使用率，CDS的设计和实施过程可能受益于更多的定制，以适应患者、就诊和提供者之间的差异和动态变化。
