通过以用户为中心和社会技术方法制定的设计原则提升临床医生对药物基因组学临床决策支持的满意度、速度与信心
Design Principles Developed through User-Centered and Socio-Technical Methods Improve Clinician Satisfaction, Speed, and Confidence in Pharmacogenomic Clinical Decision Support
AI总结：
本研究基于社会技术与用户中心方法设计并评估了11种新的药物基因组学临床决策支持警报，证明其相比原始设计能显著提升临床医生的满意度、速度和信心，并消除学习曲线。
摘要：
目的：设计并评估新的药物基因组学（PGx）临床决策支持（CDS）警报，这些警报的构建遵循了通过社会技术方法制定的PGx CDS设计原则。材料与方法：基于先前确定的设计原则，我们创建了11种新的PGx CDS警报设计，并开发了一个交互式网络应用程序，其中包含模拟真实世界电子健康档案（EHR）系统的真实临床场景和用户工作流程。我们招募了来自西北纪念医院（Northwestern Medicine）的普通内科和心脏病科临床医生，记录了他们与原始设计和新设计的交互。我们通过问卷和对记录的分析来衡量临床医生的反应、满意度、速度和信心。结果：该研究纳入了12名临床医生。与原始设计相比，参与者对新设计的满意度显著更高（p=0.0000001）、速度更快（p=0.009）、信心更强（p<0.05）。该研究缺乏足够的统计功效来确定处方准确性是否得到改善，但参与者的准确性并未降低，且在新设计下临床行为与警报交互的一致性更高（p=0.004）。我们发现原始设计存在显著的学习曲线，而新设计消除了这一学习曲线。讨论：本研究成功证明，社会技术和以用户为中心的设计技术能够改善PGx CDS警报设计。文献中关于PGx CDS设计的最佳实践有限，可用的有效性研究也很少。这些结果有助于指导未来的PGx CDS实施，使其对临床医生更加友好且更省时。结论：本研究结果支持我们在先前工作中提出的PGx CDS设计原则。下一步应在实际临床环境中实施新设计以进行进一步验证。
英文摘要：
OBJECTIVE: To design and evaluate new pharmacogenomic (PGx) clinical decision support (CDS) alerts, built to adhere to PGx CDS design principles developed through socio-technical approaches. MATERIALS AND METHODS: Based on previously identified design principles, we created 11 new PGx CDS alert designs and developed an interactive web application containing realistic clinical scenarios and user workflows that mimicked a real-world EHR system. We recruited General Internal Medicine and Cardiology clinicians from Northwestern Medicine and recorded their interactions with the original and new designs. We measured clinician response, satisfaction, speed, and confidence through questionnaires and analysis of the recordings. RESULTS: The study included 12 clinicians. Participants were significantly more satisfied (p=0.0000001), faster (p=0.009), and more confident (p<.05) with the new designs than the original ones. The study lacked statistical power to determine whether prescribing accuracy was improved, but participants were no less accurate, and clinical actions were more concordant with alert interactions (p=0.004) with the new designs. We found a significant learning curve associated with the original designs, which was eliminated with the new designs. DISCUSSION: This study successfully demonstrates that socio-technical and user-centered design techniques can improve PGx CDS alert designs. Best practices for PGx CDS design are limited in the literature, with few effectiveness studies available. These results can help guide future PGx CDS implementations to be more clinician friendly and less time-consuming. CONCLUSION: The results of this study support the PGx CDS design principles we proposed in previous work. As a next step, the new designs should be implemented in a live setting for further validation.
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