I JMIR出版物V 9 %N 2 %P 32399% T基于web的卡塔尔世界杯8强波胆分析肺癌筛查共享决策工具的实现:混合方法质量改进评估Lowery,Julie Fagerlin,Angela Larkin,Angela R %A Wiener,Renda S %A Skurla,Sarah E %A Caverly,Tanner临床管理研究中心，VA医疗系统，安娜堡，密歇根州，48105，富勒路2215号，美国，1 303 587 1038，tcaverly@med.umich.edu %K共享决策%K肺癌%K筛查%K临床决策支持%K学术详细研究%K质量改善%K实施%D 2022 %7 1.4.2022 %9原始论文%J JMIR Hum因素%G英文%X背景:符合低剂量计算机断层扫描肺癌筛查(LCS)条件的患者肺癌风险和预期寿命差异很大，这对优化不同患者的LCS决策具有重要影响。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)。方法:第一阶段包括一项多站点、聚类随机试验，比较了标准实施的有效性(添加了电子健康记录中的决策精度与标准实施以及学习、参与、行动和过程[LEAP] QI培训计划的链接)。主要结果测量是在LEAP QI训练前后在每个部位使用DecisionPrecision。研究的第二阶段考察了AD作为决策精准化实施策略在所有8个医疗中心的潜在有效性。通过比较AD就诊前后的绝对工具使用情况，并在AD就诊后对初级保健医生(pcp)进行半结构化访谈，评估结果。 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 %M 35363144 %R 10.2196/32399 %U https://humanfactors.www.mybigtv.com/2022/2/e32399 %U https://doi.org/10.2196/32399 %U http://www.ncbi.nlm.nih.gov/pubmed/35363144