背景:记忆临床专业人员和患者都看到了数字工具的价值,然而,这些几乎没有找到他们的方式到临床实践。我们探索了数字工具的可用性,以支持日常记忆临床实践中的诊断工作。我们评估了整合多模态患者数据的四个模块(1.认知测验;cCOG,和2。MRI定量;cMRI)为临床医生提供有用的诊断信息(3。cDSI)以及患者可理解和个性化的信息(4。患者报告)。
方法:我们在荷兰的五个记忆诊所进行了一项混合方法研究。14名临床医生(11名老年病专家/住院医师,两位神经科医生,邀请一名执业护士)将该工具整合到43名新的记忆门诊患者的常规护理中。我们通过问卷调查的定量数据评估了可用性和用户体验(患者,护理伙伴,临床医生),丰富了来自访谈(临床医生)的主题分析定性数据。
结果:我们观察到临床医生使用工具的差异很大。我们的核心发现是临床医生:1)对患者报告主要是积极的,因为它有助于以患者为中心和个性化的沟通。这得到了患者和护理伙伴的认可,他指出病人报告是有用的和可以理解的,并帮助他们更好地理解他们的诊断,2)认为除了自己的临床能力之外,该工具还可以接受,3)表明该工具的有用性取决于患者人群和诊断过程的目的,4)解决的促进者(易用性,实践使完美)和障碍(高工作量,缺乏经验,数据不可用)。
结论:这项多中心可用性研究表明,愿意采用数字工具来支持记忆诊所的诊断过程。临床医生,病人,和护理合作伙伴赞赏个性化的诊断报告。需要更多地关注临床医生的教育和培训,以利用该工具的全部功能并促进实际日常实践的实施。这些发现为在记忆临床实践中持久采用数字工具提供了重要的一步。
Both memory clinic professionals and patients see value in digital tools, yet these hardly find their way to clinical practice. We explored the usability of a digital tool to support the diagnostic work-up in daily memory clinic practice. We evaluated four modules that integrate multi-modal patient data (1.cognitive test; cCOG, and 2. MRI quantification; cMRI) into useful diagnostic information for clinicians (3. cDSI) and understandable and personalized information for patients (4. patient report).
We conducted a mixed-methods study in five Dutch memory clinics. Fourteen clinicians (11 geriatric specialists/residents, two neurologists, one nurse practitioner) were invited to integrate the tool into routine care with 43 new memory clinic patients. We evaluated usability and user experiences through quantitative data from questionnaires (patients, care partners, clinicians), enriched with thematically analyzed qualitative data from interviews (clinicians).
We observed wide variation in tool use among clinicians. Our core findings were that clinicians: 1) were mainly positive about the patient report, since it contributes to patient-centered and personalized communication. This was endorsed by patients and care partners, who indicated that the patient report was useful and understandable and helped them to better understand their diagnosis, 2) considered the tool acceptable in addition to their own clinical competence, 3) indicated that the usefulness of the tool depended on the patient population and purpose of the diagnostic process, 4) addressed facilitators (ease of use, practice makes perfect) and barriers (high workload, lack of experience, data unavailability).
This multicenter usability study revealed a willingness to adopt a digital tool to support the diagnostic process in memory clinics. Clinicians, patients, and care partners appreciated the personalized diagnostic report. More attention to education and training of clinicians is needed to utilize the full functionality of the tool and foster implementation in actual daily practice. These findings provide an important step towards a lasting adoption of digital tools in memory clinic practice.