卢旺达为改善1型糖尿病患者护理质量而开发电子病历系统的定性研究
The Development of an Electronic Medical Record System to Improve Quality of Care for Individuals With Type 1 Diabetes in Rwanda: Qualitative Study.
作者信息
Bille Nathalie, Christensen Dirk Lund, Byberg Stine, Calopietro Michael, Gishoma Crispin, Villadsen Sarah Fredsted
机构信息
Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
Department of Digital Health Solutions, World Diabetes Foundation, Bagsværd, Denmark.
出版信息
JMIR Diabetes. 2024 Sep 20;9:e52271. doi: 10.2196/52271.
BACKGROUND
Electronic medical record (EMR) systems have the potential to improve the quality of care and clinical outcomes for individuals with chronic and complex diseases. However, studies on the development and use of EMR systems for type 1 (T1) diabetes management in sub-Saharan Africa are few.
OBJECTIVE
The aim of this study is to analyze the need for improvements in the care processes that can be facilitated by an EMR system and to develop an EMR system for increasing quality of care and clinical outcomes for individuals with T1 diabetes in Rwanda.
METHODS
A qualitative, cocreative, and multidisciplinary approach involving local stakeholders, guided by the framework for complex public health interventions, was applied. Participant observation and the patient's personal experiences were used as case studies to understand the clinical care context. A focus group discussion and workshops were conducted to define the features and content of an EMR. The data were analyzed using thematic analysis.
RESULTS
The identified themes related to feature requirements were (1) ease of use, (2) automatic report preparation, (3) clinical decision support tool, (4) data validity, (5) patient follow-up, (6) data protection, and (7) training. The identified themes related to content requirements were (1) treatment regimen, (2) mental health, and (3) socioeconomic and demographic conditions. A theory of change was developed based on the defined feature and content requirements to demonstrate how these requirements could strengthen the quality of care and improve clinical outcomes for people with T1 diabetes.
CONCLUSIONS
The EMR system, including its functionalities and content, can be developed through an inclusive and cocreative process, which improves the design phase of the EMR. The development process of the EMR system is replicable, but the solution needs to be customized to the local context.
背景
电子病历（EMR）系统有潜力改善慢性和复杂疾病患者的护理质量及临床结局。然而，在撒哈拉以南非洲地区，针对1型（T1）糖尿病管理的电子病历系统开发与使用的研究较少。
目的
本研究旨在分析电子病历系统可促进的护理流程改进需求，并开发一个电子病历系统，以提高卢旺达T1糖尿病患者的护理质量和临床结局。
方法
采用了一种定性、共创式和多学科方法，该方法由复杂公共卫生干预框架指导，涉及当地利益相关者。通过参与观察和患者个人经历作为案例研究来了解临床护理背景。开展焦点小组讨论和研讨会以确定电子病历的功能和内容。使用主题分析法对数据进行分析。
结果
与功能需求相关的已确定主题为：（1）易用性；（2）自动报告生成；（3）临床决策支持工具；（4）数据有效性；（5）患者随访；（6）数据保护；（7）培训。与内容需求相关的已确定主题为：（1）治疗方案；（2）心理健康；（3）社会经济和人口状况。基于已定义的功能和内容需求，开发了一个变革理论，以展示这些需求如何加强T1糖尿病患者的护理质量并改善临床结局。
结论
电子病历系统，包括其功能和内容，可通过一个包容性的共创过程来开发，这改善了电子病历的设计阶段。电子病历系统的开发过程是可复制的，但解决方案需要根据当地情况进行定制。
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