The value of participatory development to support antimicrobial stewardship with a clinical decision support system

Jong, Nienke Beerlage-de; Wentzel, Jobke; Hendrix, Ron; Gemert-Pijnen, Lisette van

doi:10.1016/j.ajic.2016.12.001

Cited by 19 publications

(32 citation statements)

References 25 publications

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“…Re ecting these diverse opinions, our results emphasized the importance of a participatory process involving end-users in both the design and planned implementation of electronic CDS, 24 consistent with expert opinion. 25 While participants from all specialties generally viewed the CDS favorably, some expressed uncertainty regarding how the tool's use may differ between neurosurgeons and nonneurosurgeons.…”

Section: Discussionsupporting

confidence: 81%

Electronic Clinical Decision Support for Children with Minor Head Trauma and Intracranial Injuries: A Sociotechnical Analysis

Greenberg

Otun

Nasraddin

et al. 2020

Preprint

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Background: Current management of children with minor head trauma (MHT) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision support (CDS) for management of these children may improve patient safety and decrease resource use. To guide these efforts, we evaluated the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure, among other factors. Methods: Between March and May, 2020 semi-structured qualitative focus group interviews were conducted to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, and pediatric general surgery were included, along with information technology specialists. Participants were recruited from nine health centers in the United States. Focus group transcripts were coded and analyzed using thematic analysis. The final themes were then cross-referenced with previously defined sociotechnical dimensions.Results: We included 28 physicians and four information technology specialists in seven focus groups (median five participants per group). Five physicians were trainees and 10 had administrative leadership positions. Through inductive thematic analysis, we identified five primary themes: 1) clinical impact; 2) stakeholders and users; 3) tool content; 4) clinical practice integration; and 5) post-implementation evaluation measures. Participants generally supported using CDS to determine an appropriate level-of-care for these children. However, some had mixed feelings regarding how the tool could best be used by different specialties (e.g. use by neurosurgeons versus non-neurosurgeons). Feedback from the interviews helped refine the tool content and also highlighted potential technical and workflow barriers to address prior to implementation. Conclusions: We identified key factors impacting the implementation of electronic CDS for children with MHT and intracranial injuries. These results have informed our implementation strategy and may also serve as a template for future efforts to implement health information technology in a multidisciplinary, emergency setting.

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Section: Discussionsupporting

confidence: 81%

Electronic Clinical Decision Support for Children with Minor Head Trauma and Intracranial Injuries: A Sociotechnical Analysis

Greenberg

Otun

Nasraddin

et al. 2020

Preprint

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“…Some studies made recommendations for the implementation: they mentioned the necessity of accounting for resistance by patients and therapists, creating an infrastructure for dissemination, and financing ( 27 , 42 , 48 , 53 , 55 ). The importance of these kinds of activities has indeed been acknowledged by other studies and can be accounted for via using approaches such as business modeling ( 91 ) and participatory development ( 92 ).…”

Section: Discussionmentioning

confidence: 99%

eHealth in Treatment of Offenders in Forensic Mental Health: A Review of the Current State

Bouman²,

et al. 2018

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BackgroundTreatment of offenders in forensic mental health is complex. Often, these in- or outpatients have low treatment motivation, suffer from multiple disorders, and have poor literacy skills. eHealth may be able to improve treatment outcomes because of its potential to increase motivation and engagement, and it can overcome the predominant one-size-fits-all approach by being tailored to individual patients.ObjectiveTo examine its potential, this systematic review studies the way that eHealth has been used and studied in forensic mental health and identifies accompanying advantages and disadvantages for both patients and treatment, including effectiveness.MethodsA systematic search in Scopus, PsycINFO, and Web of Science was performed up until December 2017. Studies were included if they focused on technological interventions to improve the treatment of forensic psychiatric patients.ResultsThe search resulted in 50 studies in which eHealth was used for treatment purposes. Multiple types of studies and technologies were identified, such as virtual reality, web-based interventions, and videoconferencing. The results confirmed the benefits of technology, for example, the acquisition of unique information about offenders, effectiveness, and tailoring to specific characteristics, but indicated that these are not fully taken advantage of.DiscussionTo overcome the barriers and obtain the benefits, eHealth has to have a good fit with patients and the forensic psychiatric context. It has to be seamlessly integrated in existing care and should not be added as an isolated element. To bridge the gap between the current situation and eHealth’s potential, further research on development, implementation, and evaluation should be conducted.

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“…The online questionnaire started with a brief explanation and questions on demographics and background information. Since providing concrete examples has proven to be more suitable for eliciting participants' opinion, as opposed to merely asking them for it [5], six short videos on possible applications of VR in forensic mental health were created by a multidisciplinary project group, consisting of two patients, three therapists, two researchers and a manager. The ideas were based on earlier research that took place in the larger project: the team based the ideas on the outcomes of a previously conducted interview study on the possibilities of VR [17], focus groups and literature research on existing VR applications.…”

Section: Online Questionnairementioning

confidence: 99%

“…For an eHealth technology to be successful in practice, a good fit with the end-users and their context is key [1][2][3] This is not something that can be achieved from behind a desk: in line with approaches such as user-centered design, researchers and developers should apply a thorough development process that pays close attention to the needs and wishes of stakeholders such as patients and therapists [3][4][5]. However, potential end-users such as healthcare professionals and patients often lack time and motivation to participate, so a well-planned and structured approach is important because it is impossible to apply endless iterations [6].…”

Section: Introductionmentioning

confidence: 99%

Putting the Value in VR

Kip

Kelders

Gemert-Pijnen

2019

Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems

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In development, implementation and evaluation of eHealth it is essential to account for stakeholders' perspectives, opinions and values, which are statements that specify what stakeholders want to achieve or improve via a technology. The use of values enables developers to systematically include stakeholders' perspectives and the context of use in an eHealth development process. However, there are relatively few papers that explain how to use values in technology development. Consequently, in this paper we show how we formulated values during the multi-method, interdisciplinary and iterative development process of a VR application for a complex setting: forensic mental healthcare. We report the main foundations for these values: the outcomes of an online questionnaire with patients, therapists and other stakeholders (n=146) and interviews with patients and therapists (n=18). We show how a multidisciplinary project team used these qualitative results to formulate and adapt values and create lo-fi prototypes of a VR application. We discuss the importance of a systematic development process with multiple formative evaluations for eHealth and reflect on the role of values within this.

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The value of participatory development to support antimicrobial stewardship with a clinical decision support system

Cited by 19 publications

References 25 publications

Electronic Clinical Decision Support for Children with Minor Head Trauma and Intracranial Injuries: A Sociotechnical Analysis

Electronic Clinical Decision Support for Children with Minor Head Trauma and Intracranial Injuries: A Sociotechnical Analysis

eHealth in Treatment of Offenders in Forensic Mental Health: A Review of the Current State

Putting the Value in VR

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