Cargando…

Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses

BACKGROUND: Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance. OBJECTIVE: This study aims to characterize factors influencing successful design and use of...

Descripción completa

Detalles Bibliográficos
Autores principales: Jones, Emma K, Banks, Alyssa, Melton, Genevieve B, Porta, Carolyn M, Tignanelli, Christopher J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968578/
https://www.ncbi.nlm.nih.gov/pubmed/35293873
http://dx.doi.org/10.2196/29019
_version_ 1784679075180183552
author Jones, Emma K
Banks, Alyssa
Melton, Genevieve B
Porta, Carolyn M
Tignanelli, Christopher J
author_facet Jones, Emma K
Banks, Alyssa
Melton, Genevieve B
Porta, Carolyn M
Tignanelli, Christopher J
author_sort Jones, Emma K
collection PubMed
description BACKGROUND: Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance. OBJECTIVE: This study aims to characterize factors influencing successful design and use of comprehensive CDS care maps and identify themes associated with end-user acceptance of a thoracic trauma CDS care map earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Design development and implementation strategy for a CDS care map. This stage was based on a previously developed prototype CDS care map guided by the Unified Theory of Acceptance and Use of Technology. METHODS: A total of 22 multidisciplinary end users (physicians, advanced practice providers, and nurses) were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio-recorded, and transcribed verbatim. Generation of prespecified codes and the interview guide was informed by the Unified Theory of Acceptance and Use of Technology constructs and investigative team experience. Interviews were blinded and double-coded. Thematic analysis of interview scripts was conducted and yielded descriptive themes about factors influencing the construction and potential use of an acceptable CDS care map. RESULTS: A total of eight dominant themes were identified: alert fatigue (theme 1), automation (theme 2), redundancy (theme 3), minimalistic design (theme 4), evidence based (theme 5), prevent errors (theme 6), comprehensive across the spectrum of disease (theme 7), and malleability (theme 8). Themes 1 to 4 addressed factors directly affecting end users, and themes 5 to 8 addressed factors affecting patient outcomes. More experienced providers prioritized a system that is easy to use. Nurses prioritized a system that incorporated evidence into decision support. Clinicians across specialties, roles, and ages agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently. CONCLUSIONS: End user feedback reinforces attention toward factors that improve the acceptance and use of a CDS care map for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and optimal care provision. Identifying these factors early in the development and implementation process may facilitate user-centered design and improve adoption.
format Online
Article
Text
id pubmed-8968578
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher JMIR Publications
record_format MEDLINE/PubMed
spelling pubmed-89685782022-04-01 Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses Jones, Emma K Banks, Alyssa Melton, Genevieve B Porta, Carolyn M Tignanelli, Christopher J JMIR Hum Factors Original Paper BACKGROUND: Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance. OBJECTIVE: This study aims to characterize factors influencing successful design and use of comprehensive CDS care maps and identify themes associated with end-user acceptance of a thoracic trauma CDS care map earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Design development and implementation strategy for a CDS care map. This stage was based on a previously developed prototype CDS care map guided by the Unified Theory of Acceptance and Use of Technology. METHODS: A total of 22 multidisciplinary end users (physicians, advanced practice providers, and nurses) were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio-recorded, and transcribed verbatim. Generation of prespecified codes and the interview guide was informed by the Unified Theory of Acceptance and Use of Technology constructs and investigative team experience. Interviews were blinded and double-coded. Thematic analysis of interview scripts was conducted and yielded descriptive themes about factors influencing the construction and potential use of an acceptable CDS care map. RESULTS: A total of eight dominant themes were identified: alert fatigue (theme 1), automation (theme 2), redundancy (theme 3), minimalistic design (theme 4), evidence based (theme 5), prevent errors (theme 6), comprehensive across the spectrum of disease (theme 7), and malleability (theme 8). Themes 1 to 4 addressed factors directly affecting end users, and themes 5 to 8 addressed factors affecting patient outcomes. More experienced providers prioritized a system that is easy to use. Nurses prioritized a system that incorporated evidence into decision support. Clinicians across specialties, roles, and ages agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently. CONCLUSIONS: End user feedback reinforces attention toward factors that improve the acceptance and use of a CDS care map for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and optimal care provision. Identifying these factors early in the development and implementation process may facilitate user-centered design and improve adoption. JMIR Publications 2022-03-16 /pmc/articles/PMC8968578/ /pubmed/35293873 http://dx.doi.org/10.2196/29019 Text en ©Emma K Jones, Alyssa Banks, Genevieve B Melton, Carolyn M Porta, Christopher J Tignanelli. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 16.03.2022. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on https://humanfactors.jmir.org, as well as this copyright and license information must be included.
spellingShingle Original Paper
Jones, Emma K
Banks, Alyssa
Melton, Genevieve B
Porta, Carolyn M
Tignanelli, Christopher J
Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses
title Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses
title_full Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses
title_fullStr Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses
title_full_unstemmed Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses
title_short Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System–Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses
title_sort barriers to and facilitators for acceptance of comprehensive clinical decision support system–driven care maps for patients with thoracic trauma: interview study among health care providers and nurses
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968578/
https://www.ncbi.nlm.nih.gov/pubmed/35293873
http://dx.doi.org/10.2196/29019
work_keys_str_mv AT jonesemmak barrierstoandfacilitatorsforacceptanceofcomprehensiveclinicaldecisionsupportsystemdrivencaremapsforpatientswiththoracictraumainterviewstudyamonghealthcareprovidersandnurses
AT banksalyssa barrierstoandfacilitatorsforacceptanceofcomprehensiveclinicaldecisionsupportsystemdrivencaremapsforpatientswiththoracictraumainterviewstudyamonghealthcareprovidersandnurses
AT meltongenevieveb barrierstoandfacilitatorsforacceptanceofcomprehensiveclinicaldecisionsupportsystemdrivencaremapsforpatientswiththoracictraumainterviewstudyamonghealthcareprovidersandnurses
AT portacarolynm barrierstoandfacilitatorsforacceptanceofcomprehensiveclinicaldecisionsupportsystemdrivencaremapsforpatientswiththoracictraumainterviewstudyamonghealthcareprovidersandnurses
AT tignanellichristopherj barrierstoandfacilitatorsforacceptanceofcomprehensiveclinicaldecisionsupportsystemdrivencaremapsforpatientswiththoracictraumainterviewstudyamonghealthcareprovidersandnurses