User-centered design to improve clinical decision support in primary care

Area of Science:

• Health Informatics
• Human-Computer Interaction
• Healthcare Management

Background:

• User-centered design (UCD) enhances clinical decision support (CDS) system effectiveness and usability.
• Previous UCD studies often overlooked implementation climate and organizational resources.
• Systematic reviews highlight the need to incorporate these factors in health IT evaluations.

Purpose of the Study:

• Assess the prevalence of four UCD practices in U.S. Department of Veterans Affairs (VA) primary care clinics.
• Determine the perceived utility of CDS at these clinics.
• Evaluate the association between UCD practices and perceived CDS utility.

Main Methods:

• Analyzed survey data from 170 VA primary care clinics (2006-2007).
• Examined four UCD practices: pilot testing, provider satisfaction assessment, formal usability assessment, and analysis of impact on performance improvement.
• Used regression modeling, controlling for implementation climate, resources, and clinic structure; analyzed community-based and hospital-based clinics separately.

Main Results:

• UCD practice prevalence varied: pilot testing (74%), provider satisfaction (62%), usability assessment (36%), performance impact analysis (79%).
• Overall perceived CDS utility was high (mean rating 4.17/5).
• Analysis of impact on performance improvement was the sole UCD practice significantly associated with perceived utility (b=.47, p<.001), with a stronger association in community-based clinics.

Conclusions:

• Analyzing CDS impact on performance metrics is strongly supported by findings.
• This practice, the most common UCD method studied, correlates with higher perceived CDS utility.
• This UCD approach may be particularly beneficial for community-based clinics with fewer resources.