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Multi-method laboratory user evaluation of an actionable clinical performance information system: implications for usability and patient safety

机译:可操作的临床性能信息系统的多方法实验室用户评估:对可用性和患者安全的影响

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摘要

Introduction: Electronic audit and feedback (e-A&F) systems are used worldwide for care quality improvement. They measure health professionals' performance against clinical guidelines, and some systems suggest improvement actions. However, little is known about optimal interface designs for e-A&F, in particular how to present suggested actions for improvement. We developed a novel theory-informed system for primary care (the Performance Improvement plaN GeneratoR; PINGR) that covers the four principal interface components: clinical performance summaries; patient lists; detailed patient-level information; and suggested actions. As far as we are aware, this is the first report of an e-A&F system with all four interface components. Objectives: 1) Use a combination of quantitative and qualitative methods to evaluate the usability of PINGR with target end-users; 2) Refine existing design recommendations for e-A&F systems; 3) Determine the implications of these recommendations for patient safety. Methods: We recruited seven primary care physicians to perform seven tasks with PINGR, during which we measured on-screen behaviour and eye movements. Participants subsequently completed usability questionnaires, and were interviewed in-depth. Data were integrated to: gain a more complete understanding of usability issues; enhance and explain each other's findings; and triangulate results to increase validity. Results: Participants committed a median of 10 errors (range 8-21) in using PINGR's interface, and completed a median of five out of seven tasks (range 4-7). Errors violated six usability heuristics: clear response options; perceptual grouping and data relationships; representational formats; unambiguous description; visually distinct screens for confusable items; and workflow integration. Eye movement analysis revealed the integration of components largely supported effective user workflow, although the modular design of clinical performance summaries unnecessarily increased cognitive load. Interviews and questionnaires revealed PINGR is user-friendly, and that improved information prioritisation could promote useful user actions further. Conclusions: Comparing our results with the wider usability literature we refine a previously published set of interface design recommendations for e-A&F. The implications for patient safety are significant regarding: user engagement; actionability; and information prioritisation. Our results also support adopting multi-method approaches in usability studies to maximise: issue discovery; and the credibility of findings.
机译:简介:电子审核和反馈(e-A&F)系统在全球范围内用于改善护理质量。他们根据临床指南衡量卫生专业人员的表现,某些系统建议采取改善措施。但是,对于e-A&F的最佳界面设计知之甚少,尤其是如何提出建议的改进措施。我们开发了一种新颖的具有理论依据的基础保健系统(性能改进平台GenentoR; PINGR),该系统涵盖了四个主要的接口组件:临床性能摘要;患者名单;详细的患者水平信息;和建议的措施。据我们所知,这是具有所有四个界面组件的e-A&F系统的首次报告。目标:1)结合定量和定性方法来评估PINGR在目标最终用户中的可用性; 2)完善针对e-A&F系统的现有设计建议; 3)确定这些建议对患者安全的影响。方法:我们招募了七名初级保健医生来执行PINGR的七项任务,在此期间我们测量了屏幕上的行为和眼球运动。参与者随后完成了可用性调查表,并进行了深入访谈。整合数据是为了:对可用性问题有更完整的了解;增进和解释彼此的发现;并对结果进行三角测量以提高有效性。结果:参与者在使用PINGR的界面中犯了10个错误的中位数(范围8-21),并完成了7个任务中的5个错误(范围4-7)。错误违反了六种可用性试探法:明确的响应选项;感知分组和数据关系;代表形式;明确的描述;视觉上不同的屏幕,显示易混淆的物品;和工作流程集成。眼动分析表明,尽管临床表现的模块化设计汇总了不必要的认知负荷,但组件的集成在很大程度上支持有效的用户工作流程。访谈和调查表显示,PINGR易于使用,改进信息优先级可以进一步促进有用的用户操作。结论:将我们的结果与更广泛的可用性文献进行比较,我们完善了先前发布的针对e-A&F的一组界面设计建议。对患者安全的影响涉及以下方面:用户参与;行动能力;和信息优先。我们的结果还支持在可用性研究中采用多方法方法,以最大程度地提高:问题发现;以及调查结果的可信度。

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