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首页> 外文期刊>JMIR Medical Informatics >Design Process and Utilization of a Novel Clinical Decision Support System for Neuropathic Pain in Primary Care: Mixed Methods Observational Study
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Design Process and Utilization of a Novel Clinical Decision Support System for Neuropathic Pain in Primary Care: Mixed Methods Observational Study

机译：新型临床决策支持系统的设计过程和利用初级保健治疗神经病疼痛：混合方法观察研究

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Background Computerized clinical decision support systems (CDSSs) have emerged as an approach to improve compliance of clinicians with clinical practice guidelines (CPGs). Research utilizing CDSS has primarily been conducted in clinical contexts with clear diagnostic criteria such as diabetes and cardiovascular diseases. In contrast, research on CDSS for pain management and more specifically neuropathic pain has been limited. A CDSS for neuropathic pain has the potential to enhance patient care as the challenge of diagnosing and treating neuropathic pain often leads to tension in clinician-patient relationships. Objective The aim of this study was to design and evaluate a CDSS aimed at improving the adherence of interprofessional primary care clinicians to CPG for managing neuropathic pain. Methods Recommendations from the Canadian CPGs informed the decision pathways. The development of the CDSS format and function involved participation of multiple stakeholders and end users in needs assessment and usability testing. Clinicians, including family medicine physicians, residents, and nurse practitioners, in three academic teaching clinics were trained in the use of the CDSS. Evaluation over one year included the measurement of utilization of the CDSS; change in reported awareness, agreement, and adoption of CPG recommendations; and change in the observed adherence to CPG recommendations. Results The usability testing of the CDSS was highly successful in the prototype environment. Deployment in the clinical setting was partially complete by the time of the study, with some limitations in the planned functionality. The study population had a high level of awareness, agreement, and adoption of guideline recommendations before implementation of CDSS. Nevertheless, there was a small and statistically significant improvement in the mean awareness and adoption scores over the year of observation (P=.01 for mean awareness scores at 6 and 12 months compared with baseline, for mean adoption scores at 6 months compared with baseline, and for mean adoption scores at 12 months). Documenting significant findings related to diagnosis of neuropathic pain increased significantly. Clinicians accessed CPG information more frequently than they utilized data entry functions. Nurse practitioners and first year family medicine trainees had higher utilization than physicians. Conclusions We observed a small increase in the adherence to CPG recommendations for managing neuropathic pain. Clinicians utilized the CDSS more as a source of knowledge and as a training tool than as an ongoing dynamic decision support.
机译：背景技术计算机化临床决策支持系统（CDSS）作为提高临床医生遵守临床实践指南（CPGS）的方法。利用CDSS的研究主要是在临床环境中进行，具有明显的诊断标准，如糖尿病和心血管疾病。相比之下，对疼痛管理和更具体的神经性疼痛的CDSS的研究受到限制。由于诊断和治疗神经病疼痛的挑战通常导致临床医生关系的攻击，这是一种神经病疼痛的CDSs。目的本研究的目的是设计和评估旨在改善识别初级护理临床医生对CPG的依赖的CDS，以管理神经性疼痛。方法加拿大CPG的建议通知决策途径。 CDSS格式和功能的开发涉及多个利益相关者和最终用户参与需求评估和可用性测试。包括CDSS的三个学术教学诊所在包括CDS的三个学术教学诊所，包括家庭医学医师，居民和护士从业者。一年内的评估包括测量CDSS的利用;报告的意识，协议和采用CPG建议的变更;并改变观察到的遵守CPG建议。结果CDS的可用性测试在原型环境中非常成功。在临床环境中部署在研究时部分完成，在计划功能中有一些限制。在执行CDS之前，研究人群具有高度的认识，协议和通过指南建议。尽管如此，在观察年度的平均意识和采用分数中，在观察的年份（P = 0.01，与基线相比，6和12个月的平均意识评分的统计学意义（p = .01），与基线相比，6个月的平均收养分数，并在12个月内的平均收养分数）。记录与神经病疼痛的诊断相关的重要发现显着增加。临床医生比使用数据输入功能更频繁地访问CPG信息。护士从业者和第一年的家庭医学学员的利用率高于医生。结论我们观察到对管理神经性疼痛的依从性遵守CPG建议。临床医生将CDSS更多为知识来源，作为培训工具而不是作为持续的动态决策支持。

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