School of Nursing, Columbia University, New York, NY 10032, United States.
Center for Home Care Policy & Research, VNS Health, New York, NY 10017, United States.
J Am Med Inform Assoc. 2024 Nov 1;31(11):2641-2650. doi: 10.1093/jamia/ocae247.
To explore home healthcare (HHC) clinicians' needs for Clinical Decision Support Systems (CDSS) information delivery for early risk warning within HHC workflows.
Guided by the CDS "Five-Rights" framework, we conducted semi-structured interviews with multidisciplinary HHC clinicians from April 2023 to August 2023. We used deductive and inductive content analysis to investigate informants' responses regarding CDSS information delivery.
Interviews with thirteen HHC clinicians yielded 16 codes mapping to the CDS "Five-Rights" framework (right information, right person, right format, right channel, right time) and 11 codes for unintended consequences and training needs. Clinicians favored risk levels displayed in color-coded horizontal bars, concrete risk indicators in bullet points, and actionable instructions in the existing EHR system. They preferred non-intrusive risk alerts requiring mandatory confirmation. Clinicians anticipated risk information updates aligned with patient's condition severity and their visit pace. Additionally, they requested training to understand the CDSS's underlying logic, and raised concerns about information accuracy and data privacy.
While recognizing CDSS's value in enhancing early risk warning, clinicians highlighted concerns about increased workload, alert fatigue, and CDSS misuse. The top risk factors identified by machine learning algorithms, especially text features, can be ambiguous due to a lack of context. Future research should ensure that CDSS outputs align with clinical evidence and are explainable.
This study identified HHC clinicians' expectations, preferences, adaptations, and unintended uses of CDSS for early risk warning. Our findings endorse operationalizing the CDS "Five-Rights" framework to optimize CDSS information delivery and integration into HHC workflows.
探索家庭医疗保健（HHC）临床医生在 HHC 工作流程中对临床决策支持系统（CDSS）信息传递以实现早期风险预警的需求。
本研究以 CDS 的“五权”框架为指导，对 2023 年 4 月至 8 月的多学科 HHC 临床医生进行了半结构化访谈。我们采用演绎和归纳内容分析方法，调查了受访者对 CDSS 信息传递的反应。
对 13 名 HHC 临床医生的访谈产生了 16 个与 CDS“五权”框架（正确的信息、正确的人、正确的格式、正确的渠道、正确的时间）相对应的代码，以及 11 个意外后果和培训需求的代码。临床医生倾向于显示在彩色水平条中的风险水平、项目符号中的具体风险指标，以及现有电子健康记录系统中的可操作说明。他们更喜欢非侵入性的风险警报，需要强制性确认。临床医生预计风险信息更新与患者的病情严重程度和就诊节奏保持一致。此外，他们还要求进行培训以了解 CDSS 的底层逻辑，并对信息准确性和数据隐私表示担忧。
尽管临床医生认识到 CDSS 在增强早期风险预警方面的价值，但他们强调了对工作负荷增加、警报疲劳和 CDSS 滥用的担忧。机器学习算法确定的首要风险因素，尤其是文本特征，由于缺乏上下文可能存在歧义。未来的研究应确保 CDSS 的输出与临床证据一致，并具有可解释性。
本研究确定了 HHC 临床医生对 CDSS 进行早期风险预警的期望、偏好、适应和意外使用。我们的研究结果支持实施 CDS 的“五权”框架，以优化 CDSS 信息传递并将其集成到 HHC 工作流程中。
