BMC Med Inform Decis Mak - Effects of a computerized feedback intervention on safety performance by junior doctors: results from a randomized mixed method study.


{ intervent(3218) particip(2042) group(1664) }
{ medic(1828) order(1363) alert(1069) }
{ patient(1821) servic(1111) care(1106) }
{ health(1844) social(1437) communiti(874) }
{ measur(2081) correl(1212) valu(896) }
{ survey(1388) particip(1329) question(1065) }
{ take(945) account(800) differ(722) }
{ studi(2440) review(1878) systemat(933) }
{ system(1050) medic(1026) inform(1018) }
{ chang(1828) time(1643) increas(1301) }
{ method(984) reconstruct(947) comput(926) }
{ perform(999) metric(946) measur(919) }
{ perform(1367) use(1326) method(1137) }
{ studi(1119) effect(1106) posit(819) }
{ cost(1906) reduc(1198) effect(832) }
{ time(1939) patient(1703) rate(768) }
{ can(774) often(719) complex(702) }
{ model(2220) cell(1177) simul(1124) }
{ data(3963) clinic(1234) research(1004) }
{ blood(1257) pressur(1144) flow(957) }
{ group(2977) signific(1463) compar(1072) }
{ analysi(2126) use(1163) compon(1037) }
{ method(1219) similar(1157) match(930) }
{ treatment(1704) effect(941) patient(846) }
{ concept(1167) ontolog(924) domain(897) }
{ algorithm(1844) comput(1787) effici(935) }
{ control(1307) perform(991) simul(935) }
{ featur(1941) imag(1645) propos(1176) }
{ state(1844) use(1261) util(961) }
{ patient(2837) hospit(1953) medic(668) }
{ data(2317) use(1299) case(1017) }
{ first(2504) two(1366) second(1323) }
{ can(981) present(881) function(850) }
{ structur(1116) can(940) graph(676) }
{ process(1125) use(805) approach(778) }
{ method(2212) result(1239) propos(1039) }
{ detect(2391) sensit(1101) algorithm(908) }
{ model(3404) distribut(989) bayesian(671) }
{ imag(1947) propos(1133) code(1026) }
{ data(1737) use(1416) pattern(1282) }
{ inform(2794) health(2639) internet(1427) }
{ system(1976) rule(880) can(841) }
{ imag(1057) registr(996) error(939) }
{ bind(1733) structur(1185) ligand(1036) }
{ sequenc(1873) structur(1644) protein(1328) }
{ featur(3375) classif(2383) classifi(1994) }
{ imag(2830) propos(1344) filter(1198) }
{ network(2748) neural(1063) input(814) }
{ imag(2675) segment(2577) method(1081) }
{ patient(2315) diseas(1263) diabet(1191) }
{ motion(1329) object(1292) video(1091) }
{ assess(1506) score(1403) qualiti(1306) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ framework(1458) process(801) describ(734) }
{ problem(2511) optim(1539) algorithm(950) }
{ error(1145) method(1030) estim(1020) }
{ learn(2355) train(1041) set(1003) }
{ clinic(1479) use(1117) guidelin(835) }
{ extract(1171) text(1153) clinic(932) }
{ method(1557) propos(1049) approach(1037) }
{ data(1714) softwar(1251) tool(1186) }
{ design(1359) user(1324) use(1319) }
{ care(1570) inform(1187) nurs(1089) }
{ general(901) number(790) one(736) }
{ search(2224) databas(1162) retriev(909) }
{ case(1353) use(1143) diagnosi(1136) }
{ howev(809) still(633) remain(590) }
{ studi(1410) differ(1259) use(1210) }
{ risk(3053) factor(974) diseas(938) }
{ research(1085) discuss(1038) issu(1018) }
{ import(1318) role(1303) understand(862) }
{ model(2341) predict(2261) use(1141) }
{ visual(1396) interact(850) tool(830) }
{ compound(1573) activ(1297) structur(1058) }
{ spatial(1525) area(1432) region(1030) }
{ record(1888) medic(1808) patient(1693) }
{ health(3367) inform(1360) care(1135) }
{ model(3480) simul(1196) paramet(876) }
{ monitor(1329) mobil(1314) devic(1160) }
{ ehr(2073) health(1662) electron(1139) }
{ research(1218) medic(880) student(794) }
{ model(2656) set(1616) predict(1553) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
{ sampl(1606) size(1419) use(1276) }
{ gene(2352) biolog(1181) express(1162) }
{ data(3008) multipl(1320) sourc(1022) }
{ activ(1138) subject(705) human(624) }
{ use(2086) technolog(871) perceiv(783) }
{ high(1669) rate(1365) level(1280) }
{ cancer(2502) breast(956) screen(824) }
{ use(976) code(926) identifi(902) }
{ use(1733) differ(960) four(931) }
{ drug(1928) target(777) effect(648) }
{ result(1111) use(1088) new(759) }
{ implement(1333) system(1263) develop(1122) }
{ estim(2440) model(1874) function(577) }
{ decis(3086) make(1611) patient(1517) }
{ activ(1452) weight(1219) physic(1104) }
{ method(1969) cluster(1462) data(1082) }


CKGROUND: The behaviour of doctors and their responses to warnings can inform the effective design of Clinical Decision Support Systems. We used data from a University hospital electronic prescribing and laboratory reporting system with hierarchical warnings and alerts to explore junior doctors' behaviour. The objective of this trial was to establish whether a Junior Doctor Dashboard providing feedback on prescription warning information and laboratory alerting acceptance rates was effective in changing junior doctors' behaviour.METHODS: A mixed methods approach was employed which included a parallel group randomised controlled trial, and individual and focus group interviews. Junior doctors below the specialty trainee level 3 grade were recruited and randomised to two groups. Every doctor (N=42) in the intervention group was e-mailed a link to a personal dashboard every week for 4?months. Nineteen participated in interviews. The 44 control doctors did not receive any automated feedback. The outcome measures were the difference in responses to prescribing warnings (of two severities) and laboratory alerting (of two severities) between the months before and the months during the intervention, analysed as the difference in performance between the intervention and the control groups.RESULTS: No significant differences were observed in the rates of generating prescription warnings, or in the acceptance of laboratory alarms. However, responses to laboratory alerts differed between the pre-intervention and intervention periods. For the doctors of Foundation Year 1 grade, this improvement was significantly (p=0.002) greater in the group with access to the dashboard (53.6% ignored pre-intervention compared to 29.2% post intervention) than in the control group (47.9% ignored pre-intervention compared to 47.0% post intervention). Qualitative interview data indicated that while junior doctors were positive about the electronic prescribing functions, they were discriminating in the way they responded to other alerts and warnings given that from their perspective these were not always immediately clinically relevant or within the scope of their responsibility.CONCLUSIONS: We have only been able to provide weak evidence that a clinical dashboard providing individualized feedback data has the potential to improve safety behaviour and only in one of several domains. The construction of metrics used in clinical dashboards must take account of actual work processes.TRIAL REGISTRATION ISRCTN: ISRCTN72253051.

Resumo Limpo

ckground behaviour doctor respons warn can inform effect design clinic decis support system use data univers hospit electron prescrib laboratori report system hierarch warn alert explor junior doctor behaviour object trial establish whether junior doctor dashboard provid feedback prescript warn inform laboratori alert accept rate effect chang junior doctor behaviourmethod mix method approach employ includ parallel group randomis control trial individu focus group interview junior doctor specialti traine level grade recruit randomis two group everi doctor n intervent group email link person dashboard everi week month nineteen particip interview control doctor receiv autom feedback outcom measur differ respons prescrib warn two sever laboratori alert two sever month month intervent analys differ perform intervent control groupsresult signific differ observ rate generat prescript warn accept laboratori alarm howev respons laboratori alert differ preintervent intervent period doctor foundat year grade improv signific p greater group access dashboard ignor preintervent compar post intervent control group ignor preintervent compar post intervent qualit interview data indic junior doctor posit electron prescrib function discrimin way respond alert warn given perspect alway immedi clinic relev within scope responsibilityconclus abl provid weak evid clinic dashboard provid individu feedback data potenti improv safeti behaviour one sever domain construct metric use clinic dashboard must take account actual work processestri registr isrctn isrctn

Resumos Similares

BMC Med Inform Decis Mak - Effects of and satisfaction with short message service reminders for patient medication adherence: a randomized controlled study. ( 0,8255272625948 )
Int J Med Inform - SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored. ( 0,808825559687086 )
J. Med. Internet Res. - The effects of combining Web-based eHealth with telephone nurse case management for pediatric asthma control: a randomized controlled trial. ( 0,779887601158994 )
Appl Clin Inform - Understanding interprofessional communication: a content analysis of email communications between doctors and nurses. ( 0,77007651111093 )
J. Med. Internet Res. - The effect of program design on engagement with an internet-based smoking intervention: randomized factorial trial. ( 0,764396016406066 )
J. Med. Internet Res. - A Spanish pillbox app for elderly patients taking multiple medications: randomized controlled trial. ( 0,76421847137896 )
Int J Med Inform - Engagement in My Child's Asthma, an interactive web-based pediatric asthma management intervention. ( 0,738759726355003 )
J. Med. Internet Res. - Attrition and adherence in a WEB-Based Distress Management Program for Implantable Cardioverter defibrillator Patients (WEBCARE): randomized controlled trial. ( 0,738165852255067 )
J. Med. Internet Res. - Enhancing retention of an Internet-based cohort study of men who have sex with men (MSM) via text messaging: randomized controlled trial. ( 0,735479127681375 )
Int J Med Inform - Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. ( 0,729137505501107 )
Telemed J E Health - Two-way text messaging for health behavior change among human immunodeficiency virus-positive individuals. ( 0,727066612515205 )
J. Med. Internet Res. - Effectiveness of Web-based versus face-to-face delivery of education in prescription of falls-prevention exercise to health professionals: randomized trial. ( 0,726726598145822 )
BMC Med Inform Decis Mak - A cohort study of a tailored web intervention for preconception care. ( 0,725390985219631 )
Telemed J E Health - Effectiveness of healthy relationships video-group-A videoconferencing group intervention for women living with HIV: preliminary findings from a randomized controlled trial. ( 0,720392184986953 )
J. Med. Internet Res. - Effects of a Web-based tailored intervention to reduce alcohol consumption in adults: randomized controlled trial. ( 0,720022403056827 )
J Telemed Telecare - Cost-effectiveness of an intensive telephone-based intervention for smoking cessation. ( 0,71999693044659 )
J. Med. Internet Res. - Effect of tailoring in an internet-based intervention for smoking cessation: randomized controlled trial. ( 0,719652145765811 )
J. Med. Internet Res. - Impact of seasonality on recruitment, retention, adherence, and outcomes in a web-based smoking cessation intervention: randomized controlled trial. ( 0,718625911296628 )
J. Med. Internet Res. - Development and preliminary evaluation of an internet-based healthy eating program: randomized controlled trial. ( 0,715872708647109 )
J. Med. Internet Res. - Efficacy of a text message-based smoking cessation intervention for young people: a cluster randomized controlled trial. ( 0,715871286739814 )
J. Med. Internet Res. - Prevention of generalized anxiety disorder using a web intervention, iChill: randomized controlled trial. ( 0,71585743666974 )
J. Med. Internet Res. - Internet-based recruitment to a depression prevention intervention: lessons from the Mood Memos study. ( 0,715415010088023 )
J. Med. Internet Res. - Use of email and telephone prompts to increase self-monitoring in a Web-based intervention: randomized controlled trial. ( 0,714891742915077 )
J. Med. Internet Res. - Effectiveness of a Web-based tailored intervention (E-health4Uth) and consultation to promote adolescents' health: randomized controlled trial. ( 0,713930352598658 )
J Am Med Inform Assoc - The Diabetes Telemonitoring Study Extension: an exploratory randomized comparison of alternative interventions to maintain glycemic control after withdrawal of diabetes home telemonitoring. ( 0,713396513599344 )
J. Med. Internet Res. - Effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis: randomized controlled trial. ( 0,713235388885042 )
J. Med. Internet Res. - Internet-based brief personalized feedback intervention in a non-treatment-seeking population of adult heavy drinkers: a randomized controlled trial. ( 0,709867444725991 )
J. Med. Internet Res. - Preventing smoking relapse via Web-based computer-tailored feedback: a randomized controlled trial. ( 0,709625647545795 )
J. Med. Internet Res. - Surviving and thriving with cancer using a Web-based health behavior change intervention: randomized controlled trial. ( 0,708910066264638 )
J. Med. Internet Res. - Web-enhanced tobacco tactics with telephone support versus 1-800-QUIT-NOW telephone line intervention for operating engineers: randomized controlled trial. ( 0,708319861670475 )
J. Med. Internet Res. - Effects of internet-based tailored advice on the use of cholesterol-lowering interventions: a randomized controlled trial. ( 0,703836887035863 )
J. Med. Internet Res. - Using information technology and social networking for recruitment of research participants: experience from an exploratory study of pediatric Klinefelter syndrome. ( 0,702025212384073 )
J. Med. Internet Res. - Effectiveness of different Web-based interventions to prepare co-smokers of cigarettes and cannabis for double cessation: a three-arm randomized controlled trial. ( 0,701878391376783 )
J. Med. Internet Res. - Adherence to a smartphone application for weight loss compared to website and paper diary: pilot randomized controlled trial. ( 0,700774352638802 )
Health Informatics J - Effects of a computerized decision support system in improving pharmacological management in high-risk cardiovascular patients: A cluster-randomized open-label controlled trial. ( 0,700568404716394 )
J. Med. Internet Res. - A web-based program improves physical activity outcomes in a primary care angina population: randomized controlled trial. ( 0,698877512519826 )
J. Med. Internet Res. - A text messaging-based smoking cessation program for adult smokers: randomized controlled trial. ( 0,69822291419063 )
J Telemed Telecare - A pilot programme using mobile phones for HIV prevention. ( 0,698019981107943 )
J. Med. Internet Res. - Periodic email prompts to re-use an internet-delivered computer-tailored lifestyle program: influence of prompt content and timing. ( 0,696992800201017 )
J. Med. Internet Res. - Influence of delivery strategy on message-processing mechanisms and future adherence to a Dutch computer-tailored smoking cessation intervention. ( 0,69551501803993 )
J. Med. Internet Res. - A theory-based video messaging mobile phone intervention for smoking cessation: randomized controlled trial. ( 0,695453016883561 )
J. Med. Internet Res. - Short-term effectiveness of web-based guided self-help for phobic outpatients: randomized controlled trial. ( 0,69513942967147 )
J. Med. Internet Res. - A web-based sexual violence bystander intervention for male college students: randomized controlled trial. ( 0,693986874163336 )
Telemed J E Health - Soldiers' preferences for follow-up communications with behavioral health providers. ( 0,693926568229081 )
J. Med. Internet Res. - Efficacy of a Web-based computer-tailored smoking prevention intervention for Dutch adolescents: randomized controlled trial. ( 0,693825632733494 )
J. Med. Internet Res. - Using ecological momentary assessment to test the effectiveness of a web-based brief alcohol intervention over time among heavy-drinking students: randomized controlled trial. ( 0,692983934795563 )
J. Med. Internet Res. - Effectiveness of a Web-based multiple tailored smoking cessation program: a randomized controlled trial among Dutch adult smokers. ( 0,692110995176763 )
Telemed J E Health - Home management of oral anticoagulation via telemedicine versus conventional hospital-based treatment. ( 0,692089325925389 )
J. Med. Internet Res. - Internal versus external motivation in referral of primary care patients with depression to an internet support group: randomized controlled trial. ( 0,69186314525065 )
J. Med. Internet Res. - Interpreting the outcomes of automated internet-based randomized trials: example of an International Smoking Cessation Study. ( 0,69155089401601 )
J. Med. Internet Res. - Effects of a guided web-based smoking cessation program with telephone counseling: a cluster randomized controlled trial. ( 0,690875853674185 )
Telemed J E Health - Can an evidence-based book club intervention delivered via a tablet computer improve physical activity in middle-aged women? ( 0,68976704098352 )
J. Med. Internet Res. - Use of a text message program to raise type 2 diabetes risk awareness and promote health behavior change (part I): assessment of participant reach and adoption. ( 0,689462786836725 )
J. Med. Internet Res. - Evaluation of a Web-based intervention to promote hand hygiene: exploratory randomized controlled trial. ( 0,689450364104309 )
J. Med. Internet Res. - Effectiveness of a web-based brief alcohol intervention and added value of normative feedback in reducing underage drinking: a randomized controlled trial. ( 0,689171812409562 )
J. Med. Internet Res. - Impact of length or relevance of questionnaires on attrition in online trials: randomized controlled trial. ( 0,688980820193177 )
J. Med. Internet Res. - Two fully automated web-based interventions for risky alcohol use: randomized controlled trial. ( 0,68840238186361 )
J. Med. Internet Res. - Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. ( 0,687670296203994 )
J. Med. Internet Res. - Web-based cognitive behavioral self-help intervention to reduce cocaine consumption in problematic cocaine users: randomized controlled trial. ( 0,687340445888661 )
J. Med. Internet Res. - Engagement and retention: measuring breadth and depth of participant use of an online intervention. ( 0,686323419934144 )
J. Med. Internet Res. - Feasibility and effectiveness of a web-based positive psychology program for youth mental health: randomized controlled trial. ( 0,685549673036697 )
J. Med. Internet Res. - Effectiveness of a proactive mail-based alcohol Internet intervention for university students: dismantling the assessment and feedback components in a randomized controlled trial. ( 0,684985971519721 )
J. Med. Internet Res. - A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: randomized controlled trial. ( 0,684022656300817 )
Telemed J E Health - Evaluating opportunities for text message communication: a survey of parents and teens. ( 0,683641659256422 )
J. Med. Internet Res. - The effectiveness of a Web-based personalized feedback and social norms alcohol intervention on United Kingdom university students: randomized controlled trial. ( 0,683093528783333 )
Int J Med Inform - Evaluation of mobile phone and Internet intervention on waist circumference and blood pressure in post-menopausal women with abdominal obesity. ( 0,682122023435884 )
J. Med. Internet Res. - Text messaging data collection for monitoring an infant feeding intervention program in rural China: feasibility study. ( 0,680962135038682 )
J. Med. Internet Res. - Impact of interactive web-based education with mobile and email-based support of general practitioners on treatment and referral patterns of patients with atopic dermatitis: randomized controlled trial. ( 0,680870016212108 )
J Telemed Telecare - A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. ( 0,680183433986684 )
J. Med. Internet Res. - Partnership for health-2, a web-based versus print smoking cessation intervention for childhood and young adult cancer survivors: randomized comparative effectiveness study. ( 0,679890033184383 )
BMC Med Inform Decis Mak - Process evaluation of a web-based intervention aimed at empowerment of disability benefit claimants. ( 0,679052045751968 )
J. Med. Internet Res. - Leveraging text messaging and mobile technology to support pediatric obesity-related behavior change: a qualitative study using parent focus groups and interviews. ( 0,67747600991413 )
J. Med. Internet Res. - Exploratory study of web-based planning and mobile text reminders in an overweight population. ( 0,677448500857856 )
J Telemed Telecare - The effect of psychosocial interventions delivered by telephone and videophone on quality of life in early-stage breast cancer survivors and their supportive partners. ( 0,677355848911329 )
J. Med. Internet Res. - Does brief telephone support improve engagement with a web-based weight management intervention? Randomized controlled trial. ( 0,677048386241549 )
J. Med. Internet Res. - Motivational interviewing in a Web-based physical activity intervention with an avatar: randomized controlled trial. ( 0,676024545026054 )
J. Med. Internet Res. - A service-based evaluation of a therapist-supported online cognitive behavioral therapy program for depression. ( 0,675466478078709 )
J Telemed Telecare - Efficacy of a programme for workers with metabolic syndrome based on an e-health system in the workplace: a pilot study. ( 0,67523598479478 )
J. Med. Internet Res. - Engagement promotes abstinence in a web-based cessation intervention: cohort study. ( 0,674566632675617 )
AMIA Annu Symp Proc - Using a resource effect study pre-pilot to inform a large randomized trial: the Decide2Quit.Org Web-assisted tobacco intervention. ( 0,672818264499011 )
J. Med. Internet Res. - MEMO--a mobile phone depression prevention intervention for adolescents: development process and postprogram findings on acceptability from a randomized controlled trial. ( 0,671862485239532 )
J. Med. Internet Res. - Supporting self-care for families of children with eczema with a Web-based intervention plus health care professional support: pilot randomized controlled trial. ( 0,67173690772541 )
J. Med. Internet Res. - A smartphone-based intervention with diaries and therapist feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain. part 2: 11-month follow-up results of a randomized trial. ( 0,670993870511784 )
Appl Clin Inform - Case report: patient portal versus telephone recruitment for a surgical research study. ( 0,669434392134823 )
J. Med. Internet Res. - Online interventions for social marketing health behavior change campaigns: a meta-analysis of psychological architectures and adherence factors. ( 0,667742594980686 )
J. Med. Internet Res. - A text messaging intervention to improve heart failure self-management after hospital discharge in a largely African-American population: before-after study. ( 0,666572217581662 )
J. Med. Internet Res. - Initial and sustained participation in an internet-delivered long-term worksite health promotion program on physical activity and nutrition. ( 0,666397797284213 )
J Am Med Inform Assoc - Improving completeness of electronic problem lists through clinical decision support: a randomized, controlled trial. ( 0,665118030140913 )
J. Med. Internet Res. - Participants, usage, and use patterns of a web-based intervention for the prevention of depression within a randomized controlled trial. ( 0,663809024101789 )
J. Med. Internet Res. - Reducing alcohol use during pregnancy via health counseling by midwives and internet-based computer-tailored feedback: a cluster randomized trial. ( 0,662807896815641 )
Inform Health Soc Care - Experiences with using information and communication technology to build a multi-municipal support network for informal carers. ( 0,661808985853425 )
J. Med. Internet Res. - Effectiveness of a web-based intervention for problem drinkers and reasons for dropout: randomized controlled trial. ( 0,659890740612493 )
J. Med. Internet Res. - Economic evaluation of a web-based tailored lifestyle intervention for adults: findings regarding cost-effectiveness and cost-utility from a randomized controlled trial. ( 0,659444556052751 )
Comput Methods Programs Biomed - Quantifying the exact allocation ratios in randomized clinical trials with biased coin randomization. ( 0,658720733425414 )
J. Med. Internet Res. - Development of web-based computer-tailored advice to promote physical activity among people older than 50 years. ( 0,657913194196229 )
J. Med. Internet Res. - An internet-based virtual coach to promote physical activity adherence in overweight adults: randomized controlled trial. ( 0,657070931124669 )
J Telemed Telecare - Attitudes of women in midlife to web-based interventions for promoting physical activity. ( 0,656569218989746 )
J. Med. Internet Res. - Usage of a generic web-based self-management intervention for breast cancer survivors: substudy analysis of the BREATH trial. ( 0,656447826886722 )
J. Med. Internet Res. - Effects of a web-based patient activation intervention to overcome clinical inertia on blood pressure control: cluster randomized controlled trial. ( 0,656327588624518 )
Appl Clin Inform - Use of clinical decision support to improve the quality of care provided to older hospitalized patients. ( 0,655269081081025 )