Kaiser Permanente Division of Research, Oakland, California.
The Kaiser Permanente CREST Network, Oakland, California.
JAMA Netw Open. 2023 Nov 1;6(11):e2344393. doi: 10.1001/jamanetworkopen.2023.44393.
Clinical decision support (CDS) could help emergency department (ED) physicians treat patients with heart failure (HF) by estimating risk, collating relevant history, and assisting with medication prescribing if physicians' perspectives inform its design and implementation.
To evaluate CDS usability and workflow integration in the hands of ED physician end users who use it in clinical practice.
DESIGN, SETTING, AND PARTICIPANTS: This mixed-methods qualitative study administered semistructured interviews to ED physicians from 2 community EDs of Kaiser Permanente Northern California in 2023. The interview guide, based on the Usability Heuristics for User Interface Design and the Sociotechnical Environment models, yielded themes used to construct an electronic survey instrument sent to all ED physicians.
Main outcomes were physicians' perceptions of using CDS to complement clinical decision-making, usability, and integration into ED clinical workflow.
Seven key informant physicians (5 [71.4%] female, median [IQR] 15.0 [9.5-15.0] years in practice) were interviewed and survey responses from 51 physicians (23 [45.1%] female, median [IQR] 14.0 [9.5-17.0] years in practice) were received from EDs piloting the CDS intervention. Response rate was 67.1% (51 of 76). Physicians suggested changes to CDS accessibility, functionality, and workflow integration. Most agreed that CDS would improve patient care and fewer than half of physicians expressed hesitation about their capacity to consistently comply with its recommendations, citing workload concerns. Physicians preferred a passive prompt that encouraged, but did not mandate, interaction with the CDS.
In this qualitative study of physicians who were using a novel CDS intervention to assist with ED management of patients with acute HF, several opportunities were identified to improve usability as well as several key barriers and facilitators to CDS implementation.
临床决策支持 (CDS) 可以通过评估风险、整理相关病史以及协助开具药物处方，帮助急诊科 (ED) 医生治疗心力衰竭 (HF) 患者，前提是医生的观点能够为其设计和实施提供信息。
评估 ED 医生在临床实践中使用的 CDS 的可用性和工作流程整合情况。
设计、设置和参与者：这是一项混合方法定性研究，于 2023 年对 Kaiser Permanente Northern California 的 2 家社区 ED 的 ED 医生进行了半结构化访谈。访谈指南基于用户界面设计可用性启发式和社会技术环境模型，生成了用于构建发送给所有 ED 医生的电子调查工具的主题。
主要结果是医生对使用 CDS 来补充临床决策、可用性以及与 ED 临床工作流程整合的看法。
对 7 名关键信息提供者医生（5 名女性，[中位数（IQR）] 15.0 [9.5-15.0] 年的从业经验）进行了访谈，并从正在试用 CDS 干预措施的 ED 获得了 51 名医生（23 名女性，[中位数（IQR）] 14.0 [9.5-17.0] 年的从业经验）的调查回复。回应率为 67.1%（51/76）。医生建议对 CDS 的可访问性、功能和工作流程整合进行更改。大多数医生同意 CDS 将改善患者护理，但不到一半的医生对自己始终遵守其建议的能力表示犹豫，理由是工作量问题。医生更喜欢一个被动提示，该提示鼓励但不强制与 CDS 进行交互。
在这项对使用新型 CDS 干预措施协助 ED 管理急性 HF 患者的医生的定性研究中，确定了几个改进可用性的机会，以及 CDS 实施的几个关键障碍和促进因素。
