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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3086 — Impact of a Redesign for Colorectal Cancer Screening Computerized Decision Support

Saleem JJ (Indianapolis VAMC), Haggstrom DA (Indianapolis VAMC), Militello LG (Applied Decision Science), Flanagan M (Indiana University), Kiess CL (Regenstrief Institute), Arbuckle N (University of Dayton Research Institute), Doebbeling BN (Indianapolis VAMC)

Objectives:
Implementation of computerized clinical decision support (CDS), and its integration into workflow has not reached its potential. Based on barriers to the use of CDS learned through ethnographic observations, we prototyped design enhancements to the VHA's colorectal cancer (CRC) screening clinical reminder to compare against the VHA's current CRC reminder. Design enhancements aimed to increase quality of care included: (1) a timeline visual which integrated a patient's CRC screening history; and (2) a patient education section for the primary care providers (PCP).

Methods:
In a simulation experiment, 12 PCPs used prototypes of the current and redesigned CRC screening reminder in a within-subject comparison for four simulated patient encounters. Measurements included a workload assessment instrument (NASA Task Load Index; TLX) and usability survey (Computer System Usability Questionnaire; CSUQ). The CSUQ uses a 7-point Likert-type scale (1 = strongly disagree, 7 = strongly agree). We appended the CSUQ instrument with three statements specific to CRC screening.

Results:
PCPs rated the redesigned CRC screening reminder significantly higher for the appended statements in the CSUQ by the Wilcoxon Signed Ranks Test (two-tailed): 'It is easy to find information about the patient's colorectal cancer screening history in this system' (current design: M = 3.3, SD = 1.3; redesign M = 5.2, SD = 0.9; p = 0.015); 'It is easy to find the patient's current status with regard to colorectal cancer screening in this system' (current design: M = 3.0, SD = 1.5; redesign M = 5.3, SD = 0.8; p = 0.017); and 'The system provides helpful patient education materials for CRC screening' (current design: M = 2.8, SD = 1.7; redesign M = 5.6, SD = 0.8; p = 0.011). No additional significant differences were found in the CSUQ or the NASA TLX.

Implications:
Design enhancements to the VHA's existing CRC screening clinical reminder positively impacted PCPs' usability ratings in terms of finding the patient’s relevant data as well as for providing helpful patient education materials.

Impacts:
Very few if any controlled simulation experiments with PCPs exist in the VHA. We have demonstrated a useful method for investigation of CDS design improvements prior to implementation.


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