当刺激不移动时:混合方法研究为什么基于EHR的抑郁处方刺激未能改变提供者的行为
Ratnalekha V N Viswanadham1, Hayley M Belli1, Tiffany Rose Martinez1
1NYU Grossman School of Medicine: New York University School of Medicine.
Research square
|October 3, 2025
概括
临床决策支持 (CDS) 推动老年人服用糖尿病药物的影响有限. 提供商的分歧,工作流程问题和患者的不情愿是解除实施的关键障碍,突出了需要量身定制的战略.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 临床信息学是一种临床信息学.
- 老年医学 老年医学
背景情况:
- 取消低价值护理的实施是至关重要的,但具有挑战性.
- 电子健康记录 (EHR) 中的临床决策支持 (CDS) 推动显示了与指南一致的护理的混合有效性.
- 之前的一项随机试验使用CDS推来降低老年人的血糖药物的处方,其影响有限.
研究的目的:
- 为了评估基于EHR的CDS无效的原因,CDS推动了在2型糖尿病的老年人中促进基于指南的血糖控制.
- 识别老年患者药物管理不实施的障碍.
主要方法:
- 对67412个EHR警报的回顾性队列分析,用于血糖药物管理 (停止处方,切换,减少).
- 提供者对779个警报的评论进行主题分析.
- 后勤和多项后勤回归来评估影响nudge有效性的警报,遭遇,患者和医生级因素.
主要成果:
- 提供者评论很少见 (1.15%) 并且大多是负面的 (3.28倍更有可能).
- 不遵守的关键主题包括指导方针的不同意见,工作流的不合适以及患者的不情愿.
- 在社会弱势群体和女性提供者/患者中观察到较低的参与度.
结论:
- 由于提供者不同意,工作流失调整和患者抵抗,单独的CDS推动不足以取消实施.
- 低参与度和负面反需要综合的,基于例行的策略.
- 针对复杂性,提供者角色和以患者为中心的量身定制方法对于未来的干预措施至关重要.
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