PDF(Pubmed)
Abstract：
BACKGROUND: Improving shared decision-making using a treat-to-target approach, including the use of clinical outcome measures, is important to providing high quality care for rheumatoid arthritis (RA). We developed an Electronic Health Record (EHR) integrated, patient-facing sidecar dashboard application that displays RA outcomes, medications, and lab results for use during clinical visits (\"RA PRO dashboard\"). The purpose of this study was to assess clinician perceptions and experiences using the dashboard in a university rheumatology clinic.
METHODS: We conducted focus group (FG) discussions with clinicians who had access to the dashboard as part of a randomized, stepped-wedge pragmatic trial. FGs explored clinician perceptions towards the usability, acceptability, and usefulness of the dashboard. FG data were analyzed thematically using deductive and inductive techniques; generated themes were categorized into the domains of the Technology Acceptance Model (TAM).
RESULTS: 3 FG discussions were conducted with a total of 13 clinicians. Overall, clinicians were enthusiastic about the dashboard and expressed the usefulness of visualizing RA outcome trajectories in a graphical format for motivating patients, enhancing patient understanding of their RA outcomes, and improving communication about medications. Major themes that emerged from the FG analysis as barriers to using the dashboard included inconsistent collection of RA outcomes leading to sparse data in the dashboard and concerns about explaining RA outcomes, especially to patients with fibromyalgia. Other challenges included time constraints and technical difficulties refreshing the dashboard to display real-time data. Methods for integrating the dashboard into the visit varied: some clinicians used the dashboard at the beginning of the visit as they documented RA outcomes; others used it at the end to justify changes to therapy; and a few shared it only with stable patients.
CONCLUSIONS: The study provides valuable insights into clinicians\' perceptions and experiences with the RA PRO dashboard. The dashboard showed promise in enhancing patient-clinician communication, shared decision-making, and overall acceptance among clinicians. Addressing challenges related to data collection, education, and tailoring dashboard use to specific patient populations will be crucial for maximizing its potential impact on RA care. Further research and ongoing improvements in dashboard design and implementation are warranted to ensure its successful integration into routine clinical practice.
METHODS: We conducted focus group (FG) discussions with clinicians who had access to the dashboard as part of a randomized, stepped-wedge pragmatic trial. FGs explored clinician perceptions towards the usability, acceptability, and usefulness of the dashboard. FG data were analyzed thematically using deductive and inductive techniques; generated themes were categorized into the domains of the Technology Acceptance Model (TAM).
RESULTS: 3 FG discussions were conducted with a total of 13 clinicians. Overall, clinicians were enthusiastic about the dashboard and expressed the usefulness of visualizing RA outcome trajectories in a graphical format for motivating patients, enhancing patient understanding of their RA outcomes, and improving communication about medications. Major themes that emerged from the FG analysis as barriers to using the dashboard included inconsistent collection of RA outcomes leading to sparse data in the dashboard and concerns about explaining RA outcomes, especially to patients with fibromyalgia. Other challenges included time constraints and technical difficulties refreshing the dashboard to display real-time data. Methods for integrating the dashboard into the visit varied: some clinicians used the dashboard at the beginning of the visit as they documented RA outcomes; others used it at the end to justify changes to therapy; and a few shared it only with stable patients.
CONCLUSIONS: The study provides valuable insights into clinicians\' perceptions and experiences with the RA PRO dashboard. The dashboard showed promise in enhancing patient-clinician communication, shared decision-making, and overall acceptance among clinicians. Addressing challenges related to data collection, education, and tailoring dashboard use to specific patient populations will be crucial for maximizing its potential impact on RA care. Further research and ongoing improvements in dashboard design and implementation are warranted to ensure its successful integration into routine clinical practice.
摘要：
背景：使用治疗到目标的方法改进共享决策，包括使用临床结果测量，对于为类风湿关节炎（RA）提供高质量的护理很重要。我们开发了一个集成的电子健康记录(EHR)，显示RA结果的面向患者的侧车仪表板应用程序，药物,以及临床访视期间使用的实验室结果(“RAPRO仪表板”)。这项研究的目的是使用大学风湿病诊所的仪表板评估临床医生的看法和经验。
方法：我们与可以访问仪表板的临床医生进行了焦点小组（FG）讨论，阶梯式楔形语用试验。FGs探索了临床医生对可用性的看法，可接受性,和有用的仪表板。使用演绎和归纳技术对FG数据进行主题分析；生成的主题被归类为技术接受模型（TAM）的领域。
结果：共13名临床医生进行了3次FG讨论。总的来说,临床医生对仪表板充满热情，并表达了以图形格式可视化RA结果轨迹以激励患者的有用性。增强患者对RA结局的理解，并改善有关药物的沟通。从FG分析中出现的主要主题是使用仪表板的障碍，包括RA结果的不一致收集导致仪表板中的稀疏数据以及对解释RA结果的担忧，尤其是纤维肌痛患者。其他挑战包括时间限制和刷新仪表板以显示实时数据的技术困难。将仪表板集成到访视中的方法多种多样：一些临床医生在访视开始时使用仪表板，因为他们记录了RA结果；其他人在结束时使用它来证明改变治疗的合理性；少数人只与稳定的患者共享。
结论：该研究为临床医生对RAPRO仪表板的看法和经验提供了有价值的见解。仪表板显示出增强患者与临床医生沟通的希望，共同决策，以及临床医生的总体接受度。应对与数据收集有关的挑战，教育,并且针对特定患者人群定制仪表板用途对于最大限度地发挥其对RA护理的潜在影响至关重要.需要进一步研究和持续改进仪表板设计和实施，以确保其成功整合到常规临床实践中。
方法：我们与可以访问仪表板的临床医生进行了焦点小组（FG）讨论，阶梯式楔形语用试验。FGs探索了临床医生对可用性的看法，可接受性,和有用的仪表板。使用演绎和归纳技术对FG数据进行主题分析；生成的主题被归类为技术接受模型（TAM）的领域。
结果：共13名临床医生进行了3次FG讨论。总的来说,临床医生对仪表板充满热情，并表达了以图形格式可视化RA结果轨迹以激励患者的有用性。增强患者对RA结局的理解，并改善有关药物的沟通。从FG分析中出现的主要主题是使用仪表板的障碍，包括RA结果的不一致收集导致仪表板中的稀疏数据以及对解释RA结果的担忧，尤其是纤维肌痛患者。其他挑战包括时间限制和刷新仪表板以显示实时数据的技术困难。将仪表板集成到访视中的方法多种多样：一些临床医生在访视开始时使用仪表板，因为他们记录了RA结果；其他人在结束时使用它来证明改变治疗的合理性；少数人只与稳定的患者共享。
结论：该研究为临床医生对RAPRO仪表板的看法和经验提供了有价值的见解。仪表板显示出增强患者与临床医生沟通的希望，共同决策，以及临床医生的总体接受度。应对与数据收集有关的挑战，教育,并且针对特定患者人群定制仪表板用途对于最大限度地发挥其对RA护理的潜在影响至关重要.需要进一步研究和持续改进仪表板设计和实施，以确保其成功整合到常规临床实践中。
