Translating Research into Practice: Organizational Issues in Implementing Automated Decision Support for Hypertension in Three Medical Centers

Geriatrics Research Education and Clinical Center, 182 B, VA Palo Alto Health Care System, 3801 Miranda Avenue, CA 94304, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 09/2004; 11(5):368-76. DOI: 10.1197/jamia.M1534
Source: PubMed


Information technology can support the implementation of clinical research findings in practice settings. Technology can address the quality gap in health care by providing automated decision support to clinicians that integrates guideline knowledge with electronic patient data to present real-time, patient-specific recommendations. However, technical success in implementing decision support systems may not translate directly into system use by clinicians. Successful technology integration into clinical work settings requires explicit attention to the organizational context. We describe the application of a "sociotechnical" approach to integration of ATHENA DSS, a decision support system for the treatment of hypertension, into geographically dispersed primary care clinics. We applied an iterative technical design in response to organizational input and obtained ongoing endorsements of the project by the organization's administrative and clinical leadership. Conscious attention to organizational context at the time of development, deployment, and maintenance of the system was associated with extensive clinician use of the system.

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    • ". Other methods, such as the use of electronic data banks [32] or prescription data [33] "
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    ABSTRACT: To assess the prevalence and determinants of non-adherence to antiretroviral therapy (ART) as well as the concordance of two screening criteria in a major center for human immunodeficiency virus (HIV) treatment in Yaounde, Cameroon. In 2011, we conducted a cross-sectional study involving a random sample of 889 adults (age>18 years, 67.9% women) infected with HIV who were receiving chronic care at the Yaounde Jamot Hospital. Adherence was assessed via self-administered questionnaires using the Community Programs for Clinical Research on AIDS (CPCRA) index and the Center for Adherence Support Evaluation (CASE) index. The prevalence of non-adherence to ART was 22.5% based on the CPCRA index and 34.9% based on the CASE index, with a low agreement between the two indexes [kappa=0.37 (95% confidence interval 0.31-0.44)]. Independent determinants of CPCRA-diagnosed non-adherence were as follows: being a remunerated employee [odds ratio (95% confidence interval): 1.61 (1.14-2.28)], Pentecostal Christianity [2.18 (1.25-3.80)], alcohol consumption [1.65 (1.16-2.34)] and non-adherence to cotrimoxazole prophylaxis [5.73 (3.92-8.38)]. The equivalents for CASE-diagnosed non-adherence were [1.59 (1.19-2.12)], [1.83 (1.36-2.47)], [1.70 (1.27-2.28)], respectively, in addition to association with changes to the ART regimen [1.61 (1.17-2.20)]. Non-adherence to ART remains high in this population. The careful evaluation of patients for the presence of determinants of non-adherence identified in this study may aid ART optimization.
    08/2013; 6(4):307-315. DOI:10.1016/j.jiph.2013.02.003
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    • "They found that the systems that provide decision support as part of clinical workflow, at the time and location of decision making, as well as those that provide recommendations rather than only assessments, were associated with higher success rates[7]. In addition, the integration of other systems such as Computerised Provider Order Entry (CPOE) with the CDSS [15]; seeking clinicians’ opinion about the system [10]; and improving technical infrastructure [25] are all reported as facilitators to clinicians’ adoption of CDSS. "
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    ABSTRACT: To measure clinicians' perceptions of barriers and facilitators to the adoption of a Computerised Decision Support System (CDSS) for antibiotic approval, and to examine the correlation between these perceptions and actual usage of the system by clinicians. This study was conducted in a tertiary care university hospital of Melbourne, Australia. A survey tool comprising of demographic items and newly developed scales to measure clinicians' perceptions of barriers and facilitators to use of an CDSS was developed. Cross-sectional mail surveys were sent to 250 Junior and Senior Medical Staff and Pharmacists in a tertiary care hospital. Cronbach's alpha was used to measure the reliability of the perceptions scales. One way ANOVA was used to assess the differences between participants' responses; Tamhane's test was used for post-hoc analysis. Pearson correlations were used to measure the relationship between the participants' scores on the scales and their actual use of the CDSS under study. The overall survey response rate was 54%. Cronbach's alpha for the perceived barrier and facilitator scales were 0.80 and 0.88, respectively. Senior medical staff perceived significantly more barriers than junior medical staff and pharmacists. Statistically significant differences were observed between the scores of the participants on a number of items on the perceived barriers and facilitators scales. Negative correlations were observed between the participants' scores on the perceived barriers scale and their use of the system. (r= -0.415, p= 0.001). The scales to measure perceived barriers and facilitators to adopt antibiotic CDSS have shown acceptable reliability and validity measures. Important differences exist between senior and junior medical staff about the barriers and facilitators to adopting the CDSS which may influence future use by clinicians.
    Southern Med Review 12/2012; 5(2):42-50.
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    • "Additionally , problems occur when clinical guidelines are translated manually into working computer applications. A platform for the dynamic composition of medical services can be used [8] to address this problem, but the communication gap between domain experts and software developers and lack of domain-specific knowledge from both sides [6] [7] still poses a problem. Other approaches exist that try to provide a solution to the known difficulties with guidelines. "
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