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RRP 09-147 – HSR&D Study

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RRP 09-147
Beta Development of the Self-Management TO prevent (STOP) Stroke Tool
Jane A. Anderson PhD NP
Michael E. DeBakey VA Medical Center, Houston, TX
Houston, TX
Funding Period: October 2009 - September 2010

BACKGROUND/RATIONALE:
The Self-management TO Prevent (STOP) Stroke Tool is a clinical decision support tool that prompts providers on clinical practice guidelines for secondary stroke prevention while simultaneously providing access to patient education materials and instruction for patient self-management. We designed the initial prototype as a Reminder Dialogs (RD) template in CPRS. Testing of the template-based tool revealed usability barriers related to RD template applications.

OBJECTIVE(S):
For this project, we sought to identify redesign strategies to modify the template-based tool to produce a web-based prototype, and to complete usability testing of the web-based prototype among providers in a simulated clinic visit.

METHODS:
A pre-experimental design was applied using descriptive and qualitative methods. Members of SQUINT - the Stroke Quality Improvement Network (N=12) viewed a video of the proposed design for the web-based prototype. Implementation barriers/facilitators were elicited using an electronic evaluation form. A Think-Aloud protocol was employed to test the usability of the web-based prototype. A convenience sample of stroke-care providers (N=10) from two VAMC facilities completed the Think-Aloud protocol. Participants' responses were grouped and tabulated into content categories to identify perceived barriers/facilitators for implementation in clinical practice and for provider-to-patient communication. Audio-tapes from the Think-Aloud protocol were transcribed and investigator field notes were incorporated. A directed approach for content analysis was used to code participants' dialogue into word and word phrases that were indicative of either barriers or facilitators to accessibility, usability or usefulness.

FINDINGS/RESULTS:
SQUINT members identified the systematic format, comprehensive information, and automated features of the web-based design as facilitators to implementing the STOP Stroke Tool in practice. Barriers revolved around time to complete the tool, lack of interoperability with CPRS, and access to a printer during the encounter. Facilitation of provider-to-patient communication was identified as one key design features of the web-based interface. Barriers were possible distractions while using a computer and interacting with a patient. Usability testing indicated that access to comprehensive information was the primary accessibility facilitator. Usability facilitators were the tool's automated features and systematic process. The need for training, time to complete the tool, and computer centric care were identified as usability barriers. Usefulness facilitators of patient accountability, reminder for best practice, goal focused care, and communication/counseling indicate that the STOP Stroke Tool supports the paradigm of patient-centered care. Participants identified unclear target end-user and limited options for care other than stroke risk factor management as key usefulness barriers.

IMPACT:
This project contributes new knowledge on use of health information technology to implement and monitor quality care within the VHA. Continued research will be directed toward testing provider/patient collaborative management of stroke risk factors while using the STOP Stroke Tool as compared to usual care practices.

PUBLICATIONS:

Journal Articles

  1. Anderson JA, Godwin KM, Saleem JJ, Russell S, Robinson JJ, Kimmel B. Accessibility, usability, and usefulness of a Web-based clinical decision support tool to enhance provider-patient communication around Self-management TO Prevent (STOP) Stroke. Health Informatics Journal. 2014 Dec 1; 20(4):261-74.
  2. Anderson JA, Willson P, Peterson NJ, Murphy C, Kent TA. Prototype to practice: Developing and testing a clinical decision support system for secondary stroke prevention in a veterans healthcare facility. Computers, Informatics, Nursing : CIN. 2010 Nov 1; 28(6):353-63.
  3. Anderson JA, Willson P. Knowledge management: organizing nursing care knowledge. Critical care nursing quarterly. 2009 Jan 1; 32(1):1-9.
Journal Other

  1. Anderson JA, Saleem J, Russell S, Nedo A, Kimmel B, Robinson J, Merchant M. Usability Engineering the Self-Management TO Prevent (STOP) Stroke Tool. [Abstract]. Stroke; A Journal of Cerebral Circulation. 2011 Apr 1; 42(4):1.
  2. Anderson JA, Willson P, Kent TA. Usability Testing of the Self-management TO Prevent (STOP) Stroke Tool among Nurse Practitioner and Physician End-Users. [Abstract]. Stroke; A Journal of Cerebral Circulation. 2009 Apr 1; 40(4):e280.
Conference Presentations

  1. Anderson JA, Saleem J, Russell S, Nedo A, Kimmel B, Robinson J, Merchant M. Usability Engineering the Self-Management TO Prevent (STOP) Stroke Tool. Poster session presented at: American Heart Association / American Stroke Association International Stroke Conference; 2011 Feb 8; Los Angeles, CA.
  2. Anderson JA, Willson P, Kent TA. Prototype to Practice: Development and Alpha Testing of the STOP Stroke Tool. Paper presented at: Rutgers College of Nursing International Nursing Technology Conference; 2009 Apr 24; Washington, DC.
  3. Anderson JA, Willson P, Kent TA. Usability Testing of the Self-management TO Prevent (STOP) Stroke Tool among Nurse Practitioner and Physician End-Users. Paper presented at: American Heart Association / American Stroke Association International Stroke Conference; 2009 Feb 16; San Diego, CA.


DRA: Aging, Older Veterans' Health and Care
DRE: none
Keywords: Decision support, Quality assurance, improvement, Stroke
MeSH Terms: none

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