Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2024 Mar 12;14(3):e080610. doi: 10.1136/bmjopen-2023-080610.
To identify barriers to hospital participation in controlled cluster trials of clinical decision support (CDS) and potential strategies for addressing barriers.
Qualitative descriptive design comprising semistructured interviews.
Five hospitals in New South Wales and one hospital in Queensland, Australia.
Senior hospital staff, including department directors, chief information officers and those working in health informatics teams.
20 senior hospital staff took part. Barriers to hospital-level recruitment primarily related to perceptions of risk associated with not implementing CDS as a control site. Perceived risks included reductions in patient safety, reputational risk and increased likelihood that benefits would not be achieved following electronic medical record (EMR) implementation without CDS alerts in place. Senior staff recommended clear communication of trial information to all relevant stakeholders as a key strategy for boosting hospital-level participation in trials.
Hospital participation in controlled cluster trials of CDS is hindered by perceptions that adopting an EMR without CDS is risky for both patients and organisations. The improvements in safety expected to follow CDS implementation makes it challenging and counterintuitive for hospitals to implement EMR without incorporating CDS alerts for the purposes of a research trial. To counteract these barriers, clear communication regarding the evidence base and rationale for a controlled trial is needed.
确定医院参与临床决策支持（CDS）对照集群试验的障碍，以及解决这些障碍的潜在策略。
包括半结构化访谈的定性描述性设计。
澳大利亚新南威尔士州的五家医院和昆士兰州的一家医院。
包括部门主任、首席信息官和从事卫生信息学团队工作的高级医院工作人员。
20 名高级医院工作人员参与了研究。医院层面参与的障碍主要与不将 CDS 作为对照点实施相关的风险认知有关。感知到的风险包括患者安全降低、声誉风险增加，以及在没有 CDS 警报的情况下实施电子病历（EMR）后，利益实现的可能性增加。高级工作人员建议向所有相关利益攸关方明确传达试验信息，作为提高医院参与试验的关键策略。
医院参与 CDS 的对照集群试验受到阻碍，因为人们认为采用没有 CDS 的 EMR 对患者和组织都存在风险。由于 CDS 实施后预期会提高安全性，因此医院在没有为研究试验目的纳入 CDS 警报的情况下实施 EMR 具有挑战性且违背直觉。为了克服这些障碍，需要就对照试验的证据基础和基本原理进行清晰的沟通。
