@文章{信息:doi/10.2196/32399，作者="Lowery, Julie和Fagerlin, Angela和Larkin, Angela R和Wiener, Renda S和Skurla, Sarah E和Caverly, Tanner J"，标题="基于web的肺癌筛查共享决策工具的实现:混合方法质量改进评估"，期刊="JMIR Hum Factors"，年="2022"，月="Apr"，日="1"，卷="9"，数="2"，页数="e32399"，关键词="共享决策;肺癌;筛选;临床决策支持;学术详细;质量改进;背景:肺癌风险和预期寿命在符合低剂量ct肺癌筛查(LCS)条件的患者中存在显著差异，这对于优化不同患者的LCS决策具有重要意义。为了解释决策过程中的这种异质性，需要基于web的决策支持工具来实现快速计算并简化获取个性化信息的过程，从而更准确地为患者-临床医生的LCS讨论提供信息。我们创建了DecisionPrecision，一个面向临床医生的基于网络的决策支持工具，以帮助定制LCS讨论，以适应患者的个体化肺癌风险和估计的净收益。目的:我们的研究目的是测试在8个退伍军人事务医疗中心的初级保健中实施决策精确的两种策略:质量改进(QI)培训方法和学术详述(AD)。 Methods: Phase 1 comprised a multisite, cluster randomized trial comparing the effectiveness of standard implementation (adding a link to DecisionPrecision in the electronic health record vs standard implementation plus the Learn, Engage, Act, and Process [LEAP] QI training program). The primary outcome measure was the use of DecisionPrecision at each site before versus after LEAP QI training. The second phase of the study examined the potential effectiveness of AD as an implementation strategy for DecisionPrecision at all 8 medical centers. Outcomes were assessed by comparing absolute tool use before and after AD visits and conducting semistructured interviews with a subset of primary care physicians (PCPs) following the AD visits. Results: Phase 1 findings showed that sites that participated in the LEAP QI training program used DecisionPrecision significantly more often than the standard implementation sites (tool used 190.3, SD 174.8 times on average over 6 months at LEAP sites vs 3.5 SD 3.7 at standard sites; P<.001). However, this finding was confounded by the lack of screening coordinators at standard implementation sites. In phase 2, there was no difference in the 6-month tool use between before and after AD (95{\%} CI −5.06 to 6.40; P=.82). Follow-up interviews with PCPs indicated that the AD strategy increased provider awareness and appreciation for the benefits of the tool. However, other priorities and limited time prevented PCPs from using them during routine clinical visits. Conclusions: The phase 1 findings did not provide conclusive evidence of the benefit of a QI training approach for implementing a decision support tool for LCS among PCPs. In addition, phase 2 findings showed that our light-touch, single-visit AD strategy did not increase tool use. To enable tool use by PCPs, prediction-based tools must be fully automated and integrated into electronic health records, thereby helping providers personalize LCS discussions among their many competing demands. PCPs also need more time to engage in shared decision-making discussions with their patients. Trial Registration: ClinicalTrials.gov NCT02765412; https://clinicaltrials.gov/ct2/show/NCT02765412 ", issn="2292-9495", doi="10.2196/32399", url="https://humanfactors.www.mybigtv.com/2022/2/e32399", url="https://doi.org/10.2196/32399", url="http://www.ncbi.nlm.nih.gov/pubmed/35363144" }