Shuey Timothy C, Schubert Tyler J, Romagnoli Katrina, Cawley Dylan, Jones Laney K, Gidding Samuel S, Williams Marc S
Department of Internal Medicine, Geisinger Medical Center, Danville, PA.
Geisinger Commonwealth School of Medicine, Scranton, PA.
AMIA Annu Symp Proc. 2025 May 22;2024:1030-1039. eCollection 2024.
Evidence-based clinical guidelines serve to support clinical decision making, but implementing such guidelines into practice remains a challenge. Familial hypercholesterolemia (FH) is a high impact clinical condition that exemplifies this disconnect. Using implementation science methods, we designed clinical decision support tools embedded into the electronic health record, including a FH-focused electronic health record Smart Set and clinic note template, to improve the care of adult and pediatric patients at high-risk of FH. End-user feedback gathered through direct observations, semi-structured interviews, and deliberative engagement sessions was used to inform the development of the tools before and after pilot-testing. Clinicians desired comprehensive, guidelines-based tools that promoted collaborative care. During pilot testing, end-users provided insights into technical issues encountered with the tool's first iteration and suggested regular check-in sessions to monitor issues moving forward. This methodology can be used to surmount challenges that prevent the uptake of evidence-based guidelines into practice.
循证临床指南有助于支持临床决策，但将此类指南应用于实践仍然是一项挑战。家族性高胆固醇血症（FH）是一种具有重大影响的临床病症，体现了这种脱节。我们运用实施科学方法，设计了嵌入电子健康记录的临床决策支持工具，包括以FH为重点的电子健康记录智能集和临床记录模板，以改善FH高危成年和儿科患者的护理。通过直接观察、半结构化访谈和审议参与会议收集的最终用户反馈，用于在试点测试前后为工具的开发提供信息。临床医生需要基于指南的全面工具来促进协作护理。在试点测试期间，最终用户深入了解了该工具首次迭代中遇到的技术问题，并建议定期召开检查会议以监测后续问题。这种方法可用于克服阻碍循证指南应用于实践的挑战。
