Goldberg Debora Goetz, Soylu Tulay G, Hoffman Carolyn Faith, Kishton Rachel E, Cronholm Peter F
Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, USA.
Center for Evidence-Based Behavioral Health, Department of Psychology, George Mason University, Fairfax, VA, USA.
Digit Health. 2025 Apr 24;11:20552076251334043. doi: 10.1177/20552076251334043. eCollection 2025 Jan-Dec.
Understand the perceptions of primary care clinicians on the challenges, barriers, and successful strategies for implementing and disseminating clinical decision support (CDS) tools in primary care.
Qualitative research involving in-depth interviews with 32 primary care clinicians practicing in a range of settings across the United States. Semi-structured interviews were conducted between July 2021 and September 2023.
All participants reported using CDS tools for patient care, with high variability in the frequency of use and the type of tools used. Fewer clinicians described using machine learning-based systems and risk assessment tools using predictive analytics. Most clinicians were favorable toward enhanced use of CDS tools for patient care if used along with clinical judgment and patient preferences. Clinicians described tremendous barriers to the adoption and implementation of EMR-integrated CDS tools, including clinician resistance, organizational approval, and lack of infrastructure and resources. Clinicians stressed the importance of communicating evidence on the effectiveness of CDS tools, integrating tools with existing EMR systems, and having an easy-to-navigate interface. Strategies for the implementation of CDS tools included an organizational champion, technical assistance, and education and training.
CDS tools have the potential to be valuable assets in treating patients in primary care and could improve diagnostic accuracy, enhance personalized treatment plans, and ultimately advance the quality of patient care. There are many concerns with the use of EMR-integrated CDS tools in primary care that should be considered including evidence of the tool's effectiveness, data security and privacy protocols, workflow integration, and clinician burden.
了解基层医疗临床医生对在基层医疗中实施和推广临床决策支持（CDS）工具所面临的挑战、障碍及成功策略的看法。
采用定性研究方法，对美国各地32名基层医疗临床医生进行深入访谈。2021年7月至2023年9月期间进行了半结构化访谈。
所有参与者均报告在患者护理中使用了CDS工具，但使用频率和工具类型差异很大。较少临床医生描述使用基于机器学习的系统和使用预测分析的风险评估工具。如果与临床判断和患者偏好一起使用，大多数临床医生倾向于更多地使用CDS工具进行患者护理。临床医生描述了采用和实施电子病历集成CDS工具存在的巨大障碍，包括临床医生的抵触、组织批准以及缺乏基础设施和资源。临床医生强调了传达CDS工具有效性证据、将工具与现有电子病历系统集成以及拥有易于操作的界面的重要性。实施CDS工具的策略包括组织倡导者、技术援助以及教育和培训。
CDS工具有可能成为基层医疗中治疗患者的宝贵资产，并可提高诊断准确性、完善个性化治疗方案，最终提升患者护理质量。在基层医疗中使用电子病历集成CDS工具存在诸多问题需要考虑，包括工具有效性的证据、数据安全和隐私协议、工作流程集成以及临床医生负担。
