背景:基于临床路径逻辑和哲学的临床决策支持系统(CDSS)对于管理医疗保健质量和标准化护理流程至关重要。在护理点设置中使用这样的系统近来变得越来越频繁。然而,在低资源设置(LRS)中,这些系统经常被忽视。
目的:本研究的目的是评估LRS中用户对CDSS的接受度。
方法:在Jimma健康中心和Jimma高等二健康中心进行CDSS评估,Jimma,埃塞俄比亚。评估基于22个参数,分为6类:易用性,系统质量,信息质量,决策变更,过程变化,和用户接受。使用Mann-WhitneyU检验来调查2个健康中心之间的差异是否显着(2尾,95%CI;α=0.05)。Pearson相关性和偏最小二乘结构方程模型(PLS-SEM)用于确定影响LRS中CDSS总体接受度的关系和因素。
结果:在116种产前保健的基础上,孕妇护理,和产后护理案例,记录了73个CDSS评估响应。我们发现,2个健康中心在16个评估参数上没有显着差异。我们做到了,然而,检测6个参数的统计学差异(P<.05)。PLS-SEM结果表明,感知用户接受度的R2为0.703。更确切地说,感知的易用性(β=.015,P=.91)和信息质量(β=.149,P=.25)对CDSS接受度没有积极影响,但更确切地说,关于CDSS的系统质量和感知效益,P<.05,β=.321,β=.486。此外,感知的易用性受到信息质量和系统质量的影响,R2值为0.479,说明信息质量对易用性的影响显著,β=.678(P<.05),β=.021(P=.89),分别。此外,决策变化(β=.374,P<.05)和过程变化(β=.749,P<.05)对感知收益的影响均显着(R2=0.983)。
结论:本研究得出的结论是,用户更有可能在医疗点接受和使用CDSS,因为它很容易掌握医疗专业人员需求方面的感知益处和系统质量。我们认为,本研究中开发的CDSS接受模型揭示了特定的因素和变量,这些因素和变量构成了在LRS中有效采用和部署CDSS的步骤。
BACKGROUND: A clinical decision support system (CDSS) based on the logic and philosophy of clinical pathways is critical for managing the quality of health care and for standardizing care processes. Using such a system at a point-of-care setting is becoming more frequent these days. However, in a low-resource setting (LRS), such systems are frequently overlooked.
OBJECTIVE: The purpose of the study was to evaluate the user acceptance of a CDSS in LRSs.
METHODS: The CDSS evaluation was carried out at the Jimma Health Center and the Jimma Higher Two Health Center, Jimma, Ethiopia. The evaluation was based on 22 parameters organized into 6 categories: ease of use, system quality, information quality, decision changes, process changes, and user acceptance. A Mann-Whitney U test was used to investigate whether the difference between the 2 health centers was significant (2-tailed, 95% CI; α=.05). Pearson correlation and partial least squares structural equation modeling (PLS-SEM) was used to identify the relationship and factors influencing the overall acceptance of the CDSS in an LRS.
RESULTS: On the basis of 116 antenatal care, pregnant patient care, and postnatal care cases, 73 CDSS evaluation responses were recorded. We found that the 2 health centers did not differ significantly on 16 evaluation parameters. We did, however, detect a statistically significant difference in 6 parameters (P<.05). PLS-SEM results showed that the coefficient of determination, R2, of perceived user acceptance was 0.703. More precisely, the perceived ease of use (β=.015, P=.91) and information quality (β=.149, P=.25) had no positive effect on CDSS acceptance but, rather, on the system quality and perceived benefits of the CDSS, with P<.05 and β=.321 and β=.486, respectively. Furthermore, the perceived ease of use was influenced by information quality and system quality, with an R2 value of 0.479, indicating that the influence of information quality on the ease of use is significant but the influence of system quality on the ease of use is not, with β=.678 (P<.05) and β=.021(P=.89), respectively. Moreover, the influence of decision changes (β=.374, P<.05) and process changes (β=.749, P<.05) both was significant on perceived benefits (R2=0.983).
CONCLUSIONS: This study concludes that users are more likely to accept and use a CDSS at the point of care when it is easy to grasp the perceived benefits and system quality in terms of health care professionals\' needs. We believe that the CDSS acceptance model developed in this study reveals specific factors and variables that constitute a step toward the effective adoption and deployment of a CDSS in LRSs.