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首页> 外文期刊>BMC Medical Informatics and Decision Making >What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study
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What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study

机译：实施计算机辅助健康风险评估工具需要什么？探索性概念图研究

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Background Emerging eHealth tools could facilitate the delivery of comprehensive care in time-constrained clinical settings. One such tool is interactive computer-assisted health-risk assessments (HRA), which may improve provider-patient communication at the point of care, particularly for psychosocial health concerns, which remain under-detected in clinical encounters. The research team explored the perspectives of healthcare providers representing a variety of disciplines (physicians, nurses, social workers, allied staff) regarding the factors required for implementation of an interactive HRA on psychosocial health. Methods The research team employed a semi-qualitative participatory method known as Concept Mapping, which involved three distinct phases. First, in face-to-face and online brainstorming sessions, participants responded to an open-ended central question: “What factors should be in place within your clinical setting to support an effective computer-assisted screening tool for psychosocial risks?” The brainstormed items were consolidated by the research team. Then, in face-to-face and online sorting sessions, participants grouped the items thematically as ‘it made sense to them’. Participants also rated each item on a 5-point scale for its ‘importance’ and ‘action feasibility’ over the ensuing six month period. The sorted and rated data was analyzed using multidimensional scaling and hierarchical cluster analyses which produced visual maps. In the third and final phase, the face-to-face Interpretation sessions, the concept maps were discussed and illuminated by participants collectively. Results Overall, 54 providers participated (emergency care 48%; primary care 52%). Participants brainstormed 196 items thought to be necessary for the implementation of an interactive HRA emphasizing psychosocial health. These were consolidated by the research team into 85 items. After sorting and rating, cluster analysis revealed a concept map with a seven-cluster solution: 1) the HRA’s equitable availability; 2) the HRA’s ease of use and appropriateness; 3) the content of the HRA survey; 4) patient confidentiality and choice; 5) patient comfort through humanistic touch; 6) professional development, care and workload; and 7) clinical management protocol. Drawing insight from the theoretical lens of Sociotechnical theory, the seven clusters of factors required for HRA implementation could be read as belonging to three overarching aspects : Technical (cluster 1, 2 and 3), Social-Patient (cluster 4 and 5), and Social-Provider (cluster 6 and 7). Participants rated every one of the clusters as important, with mean scores from 4.0 to 4.5. Their scores for feasibility were somewhat lower, ranging from 3.4 to. 4.3. Comparing the scores for importance and feasibility, a significant difference was found for one cluster from each region (cluster 2, 5, 6). The cluster on professional development, care and workload was perceived as especially challenging in emergency department settings, and possible reasons were discussed in the interpretation sessions. Conclusion A number of intertwined multilevel factors emerged as important for the implementation of a computer-assisted, interactive HRA with a focus on psychosocial health. Future developments in this area could benefit from systems thinking and insights from theoretical perspectives, such as sociotechnical system theory for joint optimization and responsible autonomy, with emphasis on both the technical and social aspects of HRA implementation.
机译：背景技术新兴的eHealth工具可以促进在时间紧迫的临床环境中提供全面护理。一种这样的工具是交互式计算机辅助健康风险评估（HRA），它可以改善医疗点的提供者与患者之间的沟通，尤其是对于心理社会健康方面的关注，在临床遭遇中仍未得到足够的重视。研究团队探讨了代表各种学科（医生，护士，社会工作者，专职人员）的医疗保健提供者的观点，这些观点涉及实施社会心理健康互动式HRA所需的因素。方法研究团队采用了一种称为概念映射的半定性参与方法，该方法涉及三个不同的阶段。首先，在面对面和在线头脑风暴会议上，与会人员回答了一个开放性的中心问题：“在您的临床环境中应采用哪些因素来支持有效的计算机辅助心理社会风险筛查工具？”头脑风暴的项目由研究团队进行了合并。然后，在面对面和在线分类会议中，与会人员按照“对他们有意义”的主题对项目进行了分组。参加者们还对每个项目在接下来的六个月内的“重要性”和“行动可行性”进行了5分制评分。使用多维缩放和层次聚类分析来分析排序和定级的数据，从而生成可视化地图。在第三个也是最后一个阶段，即面对面的口译会议上，概念图由参与者集体讨论和阐明。结果总体上，有54名医疗服务提供者参加了调查（紧急护理48％;初级医疗52％）。参与者集思广益了196个项目，这些项目被认为对于实施强调心理社会健康的交互式HRA必不可少。研究小组将这些内容合并为85个项目。经过排序和评级后，聚类分析显示了具有七类解决方案的概念图：1）人力资源管理局的公平可用性; 2）HRA的易用性和适当性; 3）HRA调查的内容; 4）患者的保密和选择; 5）通过人性化的触摸使患者感到舒适; 6）专业发展，护理和工作量; 7）临床管理方案。从社会技术理论的理论视角出发，HRA实施所需的七个因素组可以理解为属于三个总体方面：技术（第1、2和3组），社会患者（第4和5组）和社会提供者（第6和第7类）。参与者对每个集群的评价为重要，平均分从4.0到4.5。他们的可行性得分较低，为3.4至。 4.3。比较重要性和可行性的分数，发现每个区域的一个集群存在显着差异（集群2、5、6）。在急诊部门设置中，关于专业发展，护理和工作量的集群被认为是特别具有挑战性的，在解释会议上讨论了可能的原因。结论许多相互交织的多层次因素对于以计算机辅助，交互式HRA的实施（以心理社会健康为重点）的重要性显得尤为重要。该领域的未来发展可能会受益于系统思维和理论观点的见解，例如用于联合优化和负责任自治的社会技术系统理论，重点是HRA实施的技术和社会方面。

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