BMC Med Inform Decis Mak - Development of a prototype clinical decision support tool for osteoporosis disease management: a qualitative study of focus groups.

Tópicos

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

Resumo

CKGROUND: Osteoporosis affects over 200 million people worldwide, and represents a significant cost burden. Although guidelines are available for best practice in osteoporosis, evidence indicates that patients are not receiving appropriate diagnostic testing or treatment according to guidelines. The use of clinical decision support systems (CDSSs) may be one solution because they can facilitate knowledge translation by providing high-quality evidence at the point of care. Findings from a systematic review of osteoporosis interventions and consultation with clinical and human factors engineering experts were used to develop a conceptual model of an osteoporosis tool. We conducted a qualitative study of focus groups to better understand physicians' perceptions of CDSSs and to transform the conceptual osteoporosis tool into a functional prototype that can support clinical decision making in osteoporosis disease management at the point of care.METHODS: The conceptual design of the osteoporosis tool was tested in 4 progressive focus groups with family physicians and general internists. An iterative strategy was used to qualitatively explore the experiences of physicians with CDSSs; and to find out what features, functions, and evidence should be included in a working prototype. Focus groups were conducted using a semi-structured interview guide using an iterative process where results of the first focus group informed changes to the questions for subsequent focus groups and to the conceptual tool design. Transcripts were transcribed verbatim and analyzed using grounded theory methodology.RESULTS: Of the 3 broad categories of themes that were identified, major barriers related to the accuracy and feasibility of extracting bone mineral density test results and medications from the risk assessment questionnaire; using an electronic input device such as a Tablet PC in the waiting room; and the importance of including well-balanced information in the patient education component of the osteoporosis tool. Suggestions for modifying the tool included the addition of a percentile graph showing patients' 10-year risk for osteoporosis or fractures, and ensuring that the tool takes no more than 5 minutes to complete.CONCLUSIONS: Focus group data revealed the facilitators and barriers to using the osteoporosis tool at the point of care so that it can be optimized to aid physicians in their clinical decision making.

Resumo Limpo

ckground osteoporosi affect million peopl worldwid repres signific cost burden although guidelin avail best practic osteoporosi evid indic patient receiv appropri diagnost test treatment accord guidelin use clinic decis support system cdsss may one solut can facilit knowledg translat provid highqual evid point care find systemat review osteoporosi intervent consult clinic human factor engin expert use develop conceptu model osteoporosi tool conduct qualit studi focus group better understand physician percept cdsss transform conceptu osteoporosi tool function prototyp can support clinic decis make osteoporosi diseas manag point caremethod conceptu design osteoporosi tool test progress focus group famili physician general internist iter strategi use qualit explor experi physician cdsss find featur function evid includ work prototyp focus group conduct use semistructur interview guid use iter process result first focus group inform chang question subsequ focus group conceptu tool design transcript transcrib verbatim analyz use ground theori methodologyresult broad categori theme identifi major barrier relat accuraci feasibl extract bone miner densiti test result medic risk assess questionnair use electron input devic tablet pc wait room import includ wellbalanc inform patient educ compon osteoporosi tool suggest modifi tool includ addit percentil graph show patient year risk osteoporosi fractur ensur tool take minut completeconclus focus group data reveal facilit barrier use osteoporosi tool point care can optim aid physician clinic decis make

Resumos Similares

Int J Med Inform - The effect of computerized decision support on barriers to guideline implementation: a qualitative study in outpatient cardiac rehabilitation. ( 0,781186068007958 )
J Am Med Inform Assoc - Effect of clinical decision support on documented guideline adherence for head CT in emergency department patients with mild traumatic brain injury. ( 0,765871115159723 )
BMC Med Inform Decis Mak - Deficiencies in the transfer and availability of clinical trials evidence: a review of existing systems and standards. ( 0,750342308153862 )
BMC Med Inform Decis Mak - Practice guidelines and clinical risk assessment models: is it time to reform? ( 0,737334341346131 )
Med Decis Making - Toward Minimum Standards for Certifying Patient Decision Aids: A Modified Delphi Consensus Process. ( 0,731648570063329 )
AMIA Annu Symp Proc - Extending the GuideLine Implementability Appraisal (GLIA) instrument to identify problems in control flow. ( 0,710010005718994 )
Int J Med Inform - Complexity and the science of implementation in health IT--knowledge gaps and future visions. ( 0,703144175176618 )
BMC Med Inform Decis Mak - A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties. ( 0,691784052683254 )
J. Med. Internet Res. - An evaluation of web-based clinical practice guidelines for managing problems associated with cannabis use. ( 0,688322100454444 )
Methods Inf Med - From clinical practice guidelines to computer-interpretable guidelines. A literature overview. ( 0,687299070184082 )
Health Informatics J - Accessibility, usability, and usefulness of a Web-based clinical decision support tool to enhance provider-patient communication around Self-management TO Prevent (STOP) Stroke. ( 0,686173445986196 )
Appl Clin Inform - Monitoring adherence to evidence-based practices: a method to utilize HL7 messages from hospital information systems. ( 0,683506569367803 )
J Am Med Inform Assoc - Building better guidelines with BRIDGE-Wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability. ( 0,67514940678051 )
BMC Med Inform Decis Mak - A study of clinical and information management processes in the surgical pre-assessment clinic. ( 0,675023555397689 )
J. Med. Internet Res. - Feasibility of a wiki as a participatory tool for patients in clinical guideline development. ( 0,673631420551033 )
J Clin Monit Comput - Ventilator-associated pneumonia: current status and future recommendations. ( 0,667759442815855 )
AMIA Annu Symp Proc - GEM at 10: a decade's experience with the Guideline Elements Model. ( 0,666889442233595 )
BMC Med Inform Decis Mak - A systematic development process for patient decision aids. ( 0,666034644856179 )
Artif Intell Med - Aggregating evidence about the positive and negative effects of treatments. ( 0,665225742979523 )
AMIA Annu Symp Proc - Making audit actionable: an example algorithm for blood pressure management in chronic kidney disease. ( 0,662031281747273 )
Telemed J E Health - Utilization of the American Telemedicine Association's clinical practice guidelines. ( 0,657929397429768 )
Int J Med Inform - Towards an understanding of the information dynamics of the handover process in aged care settings--a prerequisite for the safe and effective use of ICT. ( 0,654929236907313 )
BMC Med Inform Decis Mak - Many miles to go ?: a systematic review of the implementation of patient decision support interventions into routine clinical practice. ( 0,653430056529611 )
BMC Med Inform Decis Mak - Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study. ( 0,645740844207392 )
Perspect Health Inf Manag - Distributed guidelines (DiG): a software framework for extending automated health decision support to the general population. ( 0,642052953541803 )
BMC Med Inform Decis Mak - Use of handheld computers in clinical practice: a systematic review. ( 0,641261696405857 )
Int J Med Inform - Dashboards for improving patient care: review of the literature. ( 0,640560559364656 )
J. Med. Internet Res. - Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. ( 0,638640414241558 )
AMIA Annu Symp Proc - An Algorithm Using Twelve Properties of Antibiotics to Find the Recommended Antibiotics, as in CPGs. ( 0,633574586591186 )
J Am Med Inform Assoc - High-priority drug-drug interactions for use in electronic health records. ( 0,631511325448502 )
Comput Methods Programs Biomed - A real time online assessment system with modelized architecture on clinical infometrics for patient reported outcomes of prostate cancer. ( 0,629820736036568 )
AMIA Annu Symp Proc - Inter-observer reliability assessments in time motion studies: the foundation for meaningful clinical workflow analysis. ( 0,628908943612862 )
Int J Med Inform - From clinical practice guidelines, to clinical guidance in practice - impacts for computerization. ( 0,628334054454889 )
J Biomed Inform - Computer-interpretable clinical guidelines: a methodological review. ( 0,628333949791726 )
AMIA Annu Symp Proc - Developing nursing computer interpretable guidelines: a feasibility study of heart failure guidelines in homecare. ( 0,626357372698644 )
J Biomed Inform - The impact of emerging standards adoption on automated quality reporting. ( 0,626088763625353 )
Appl Clin Inform - An internet portal for the development of clinical practice guidelines. ( 0,623023001968791 )
Res Synth Methods - A tool to assess the quality of a meta-analysis. ( 0,62112720338636 )
Comput. Biol. Med. - Towards automated generation and execution of clinical guidelines: engine design and implementation through the ICU Modified Schofield use case. ( 0,618505627007019 )
Med Decis Making - Methods for systematic reviews of health economic evaluations: a systematic review, comparison, and synthesis of method literature. ( 0,617085544915324 )
Comput Methods Programs Biomed - Supporting adaptive clinical treatment processes through recommendations. ( 0,613861518447334 )
Int J Med Inform - Evaluation of a comprehensive EHR based on the DeLone and McLean model for IS success: approach, results, and success factors. ( 0,612989911071773 )
Med Decis Making - Early benefit assessment of pharmaceuticals in Germany: manufacturers' expectations versus the Federal Joint Committee's decisions. ( 0,612691249227479 )
J Biomed Inform - Feasibility of encoding the Institute for Clinical Systems Improvement Depression Guideline using the Omaha System. ( 0,60843188885342 )
AMIA Annu Symp Proc - Exceptions handling within GLARE clinical guideline framework. ( 0,606781255947928 )
Med Decis Making - Divergent intentions to use antibiotic guidelines: a theory of planned behavior survey. ( 0,603036896556537 )
BMC Med Inform Decis Mak - A systematic review of the implementation and impact of asthma protocols. ( 0,601277913785419 )
Res Synth Methods - Issues relating to selective reporting when including non-randomized studies in systematic reviews on the effects of healthcare interventions. ( 0,600718303003569 )
J Am Med Inform Assoc - How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use. ( 0,598294489655466 )
Int J Med Inform - Designing for collaborative interpretation in telemonitoring: re-introducing patients as diagnostic agents. ( 0,596215446112389 )
Comput. Biol. Med. - Evaluation of personal health record systems through the lenses of EC research projects. ( 0,596095618618071 )
Health Info Libr J - The application and value of information sources in clinical practice: an examination of the perspective of naturopaths. ( 0,595431668644751 )
BMC Med Inform Decis Mak - Beyond the threshold: real-time use of evidence in practice. ( 0,5940319478709 )
BMC Med Inform Decis Mak - Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system. ( 0,593632998314774 )
AMIA Annu Symp Proc - Representation of Clinical Nursing Protocols Using GEM II & GEM Cutter. ( 0,589874530541664 )
Int J Med Inform - Changing course to make clinical decision support work in an HIV clinic in Kenya. ( 0,587825722791659 )
J Am Med Inform Assoc - A multi-layered framework for disseminating knowledge for computer-based decision support. ( 0,586716902959804 )
BMC Med Inform Decis Mak - Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas. ( 0,584899245654518 )
Res Synth Methods - Quality assessment of qualitative evidence for systematic review and synthesis: Is it meaningful, and if so, how should it be performed? ( 0,583683418655676 )
Appl Clin Inform - Actionable recommendations in the Bright Futures child health supervision guidelines. ( 0,581018197085981 )
J Am Med Inform Assoc - Validity of electronic health record-derived quality measurement for performance monitoring. ( 0,580468025101417 )
Healthc (Amst) - Meaningful use: Floor or ceiling? ( 0,580253580023758 )
Appl Clin Inform - The association between use of a clinical decision support tool and adherence to monitoring for medication-laboratory guidelines in the ambulatory setting. ( 0,578901855795605 )
BMC Med Inform Decis Mak - How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines. ( 0,578275600283845 )
Int J Med Inform - Updating clinical knowledge: an evaluation of current information alerting services. ( 0,577363480398398 )
BMC Med Inform Decis Mak - Evaluating genomic tests from bench to bedside: a practical framework. ( 0,577155845573436 )
Res Synth Methods - Potential uses of Bayesian networks as tools for synthesis of systematic reviews of complex interventions. ( 0,576666125210843 )
AMIA Annu Symp Proc - Multiple perspectives on the meaning of clinical decision support. ( 0,574692655370374 )
J Am Med Inform Assoc - Combining structured and unstructured data to identify a cohort of ICU patients who received dialysis. ( 0,573339224787379 )
J. Med. Internet Res. - WikiBuild: a new application to support patient and health care professional involvement in the development of patient support tools. ( 0,573186652604301 )
BMC Med Inform Decis Mak - Quality of prenatal and maternal care: bridging the know-do gap (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa. ( 0,570767832451133 )
Health Info Libr J - Evaluating clinical librarian services: a systematic review. ( 0,565210802551014 )
BMC Med Inform Decis Mak - Disclosing conflicts of interest in patient decision aids. ( 0,565023180240233 )
J Am Med Inform Assoc - The feasibility of automating audit and feedback for ART guideline adherence in Malawi. ( 0,564645864318261 )
Telemed J E Health - International trauma teleconference: evaluating trauma care and facilitating quality improvement. ( 0,563269929097524 )
Med Decis Making - Content coding for contextualization of care: evaluating physician performance at patient-centered decision making. ( 0,563204998576335 )
J Med Syst - EHR implementation in a new clinic: a case study of clinician perceptions. ( 0,563119560109148 )
J Am Med Inform Assoc - Evaluation of computer-generated reminders to improve CD4 laboratory monitoring in sub-Saharan Africa: a prospective comparative study. ( 0,562965393183422 )
BMC Med Inform Decis Mak - General practitioners' attitudes and preparedness towards Clinical Decision Support in e-Prescribing (CDS-eP) adoption in the West of Ireland: a cross sectional study. ( 0,562243561522464 )
AMIA Annu Symp Proc - Knowledge crystallization and clinical priorities: evaluating how physicians collect and synthesize patient-related data. ( 0,561982309374648 )
BMC Med Inform Decis Mak - Validating archetypes for the Multiple Sclerosis Functional Composite. ( 0,561263147454097 )
Brief. Bioinformatics - A survey of error-correction methods for next-generation sequencing. ( 0,560462436090694 )
Health Info Libr J - The Clinical Relevance of Information Index (CRII): assessing the relevance of health information to the clinical practice. ( 0,560295391889288 )
J. Med. Internet Res. - Clinicians' expectations of Web 2.0 as a mechanism for knowledge transfer of stroke best practices. ( 0,55978724187709 )
Telemed J E Health - Is there an improvement on the Web sites of the national and international pharmaceutical companies in Turkey? A follow-up study. ( 0,558482931924779 )
Res Synth Methods - Survey of the methods and reporting practices in published meta-analyses of test performance: 1987 to 2009. ( 0,558434096175574 )
J. Med. Internet Res. - Pain-QuILT: clinical feasibility of a web-based visual pain assessment tool in adults with chronic pain. ( 0,557826985755538 )
AMIA Annu Symp Proc - Optimization of an EHR mobile application using the UFuRT conceptual framework. ( 0,557352779808252 )
Health Info Libr J - Evidence-based medicine: is the evidence out there for primary care clinicians? ( 0,554973278781144 )
Med Decis Making - Decision modeling of disagreements: pediatric hematologists' management of idiopathic thrombocytopenic purpura. ( 0,553397668200788 )
Health Info Libr J - How doctors make use of online, point-of-care clinical decision support systems: a case study of UpToDate?. ( 0,550693208716078 )
J. Med. Internet Res. - Human computation as a new method for evidence-based knowledge transfer in Web-based guideline development groups: proof of concept randomized controlled trial. ( 0,550176376097789 )
Int J Med Inform - The IT productivity paradox in health: a stakeholder's perspective. ( 0,54950495451841 )
Int J Med Inform - Development and evaluation of data entry templates based on the entity-attribute-value model for clinical decision support of pressure ulcer wound management. ( 0,548768996406922 )
J Am Med Inform Assoc - An informatics approach to medication adherence assessment and improvement using clinical, billing, and patient-entered data. ( 0,547531531484315 )
Appl Clin Inform - CAH to CAH: EHR implementation advice to critical access hospitals from peer experts and other key informants. ( 0,54604150655041 )
AMIA Annu Symp Proc - Time Capture Tool (TimeCaT): development of a comprehensive application to support data capture for Time Motion Studies. ( 0,544666658268583 )
J Telemed Telecare - Costs and benefits of tele-endoscopy clinics in a remote location. ( 0,542823608725141 )
BMC Med Inform Decis Mak - Bridging the gaps in the Health Management Information System in the context of a changing health sector. ( 0,542723133480875 )
J Med Syst - Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. ( 0,541839135302664 )