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

Published:January 14, 2017DOI:https://doi.org/10.1016/j.ajic.2016.12.001

      Highlights

      • Current Clinical Decision Support Systems for ASP are guideline- or expert-driven.
      • A participatory development process improves their fit with clinical practice.
      • Scenario-based prototype evaluations with end-users give insight in their needs.
      • Involving multiple stakeholders can provide insight in unrecognized needs.
      • Support for selection of diagnostic tests is such unrecognized but relevant need.

      Background

      Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of CDSSs in ASPs.

      Methods

      A mixed-methods approach was applied, combining scenario-based prototype evaluations (to support verbalization of work processes and out-of-the-box thinking) among 6 medical resident physicians with an online questionnaire (to cross-reference findings of the prototype evaluations) among 54 Dutch physicians.

      Results

      The prototype evaluations resulted in insight into the end-users and their way of working, as well as their needs and expectations. The online questionnaire that was distributed among a larger group of medical specialists, including lung and infection experts, complemented the findings of the prototype evaluations. It revealed a say/do problem concerning the unrecognized need of support for selecting diagnostic tests.

      Conclusions

      Low-fidelity prototypes of a technology allow researchers to get to know the end-users, their way of working, and their work context. Involving experts allows technology developers to continuously check the fit between technology and clinical practice. The combination enables the participatory development of technology to successfully support ASPs.

      Key Words

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      References

        • Beerlage-de Jong N.
        Opening the black box of Clinical Decision Support Systems for Antimicrobial Stewardship—a scoping review.
        Int J Med Inform. 2017; (Submitted)
        • Dik J.-W.H.
        • Poelman R.
        • Friedrich A.W.
        • Panday P.N.
        • Lo-Ten-Foe J.R.
        • van Assen S.
        • et al.
        An integrated stewardship model: antimicrobial, infection prevention and diagnostic (AID).
        Future Microbiol. 2016; 11: 93-102https://doi.org/10.2217/fmb.15.99
        • MacDougall C.
        • Polk R.E.
        Antimicrobial stewardship programs in health care systems.
        Clin Microbiol Rev. 2005; 18: 638-656https://doi.org/10.1128/CMR.18.4.638-656.2005
        • Davey P.
        • Brown E.
        • Charani E.
        • Fenelon L.
        • Gould I.M.
        • Holmes A.
        • et al.
        Interventions to improve antibiotic prescribing practices for hospital inpatients.
        Cochrane Database Syst Rev. 2013; (CD003543)https://doi.org/10.1002/14651858.CD003543.pub3
        • Limburg A.H.M.
        Implementing antibiotic stewardship: involving stakeholders in eHealth.
        University of Twente, Enschede, The Netherlands2016
        • Hum R.S.
        • Cato K.
        • Sheehan B.
        • Patel S.
        • Duchon J.
        • DeLaMora P.
        • et al.
        Developing clinical decision support within a commercial electronic health record system to improve antimicrobial prescribing in the neonatal ICU.
        Appl Clin Inform. 2014; 5: 368-387https://doi.org/10.4338/ACI-2013-09-RA-0069
        • Bourgeois F.C.
        • Linder J.
        • Johnson S.A.
        • Co J.P.
        • Fiskio J.
        • Ferris T.G.
        Impact of a computerized template on antibiotic prescribing for acute respiratory infections in children and adolescents.
        Clin Pediatr (Phila). 2010; 49: 976-983https://doi.org/10.1177/0009922810373649
        • Nachtigall I.
        • Tafelski S.
        • Deja M.
        • Halle E.
        • Grebe M.C.
        • Tamarkin A.
        • et al.
        Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective “before/after” cohort study.
        BMJ Open. 2014; 4: e005370https://doi.org/10.1136/bmjopen-2014-005370
        • Hulscher M.E.
        • Grol R.P.
        • van der Meer J.W.
        Antibiotic prescribing in hospitals: a social and behavioural scientific approach.
        Lancet Infect Dis. 2010; 10: 167-175https://doi.org/10.1016/S1473-3099(10)70027-X
        • Janes C.R.
        • Corbett K.K.
        • Jones J.H.
        • Trostle J.
        Emerging infectious diseases: the role of social sciences.
        Lancet. 2012; 380: 1884-1886https://doi.org/10.1016/S0140-6736(12)61725-5
        • Carroll J.M.
        • Rosson M.B.
        • Chin Jr, G.
        • Koenemann J.
        Requirements development in scenario-based design.
        IEEE Trans Softw Eng. 1998; 24: 1156-1170https://doi.org/10.1109/32.738344
        • Bødker K.
        • Kensing F.
        • Simonsen J.
        Participatory IT design: designing for business and workplace realities.
        MIT Press, Cambridge (MA)2009
        • Dellinger R.P.
        • Levy M.M.
        • Rhodes A.
        • Annane D.
        • Gerlach H.
        • Opal S.M.
        • et al.
        Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.
        Intensive Care Med. 2013; : 165-228https://doi.org/10.1097/CCM.0b013e31827e83af
        • Müller F.
        • Christ-Crain M.
        • Bregenzer T.
        • Krause M.
        • Zimmerli W.
        • Mueller B.
        • et al.
        Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial.
        Chest. 2010; 138: 121-129https://doi.org/10.1378/chest.09-2920
        • Watkins R.R.
        • Lemonovich T.L.
        Diagnosis and management of community-acquired pneumonia in adults.
        Am Fam Physician. 2011; 83: 1299-1306
        • Nikolaus S.
        • Bode C.
        • Taal E.
        • vd Laar M.A.
        Selection of items for a computer-adaptive test to measure fatigue in patients with rheumatoid arthritis: a Delphi approach.
        Qual Life Res. 2012; 21: 863-872
        • Powell C.
        The Delphi technique: myths and realities.
        J Adv Nurs. 2003; 41: 376-382
        • Lim W.
        • van der Eerden M.M.
        • Laing R.
        • Boersma W.G.
        • Karalus N.
        • Town G.I.
        • et al.
        Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.
        Thorax. 2003; 58: 377-382
        • Wentzel J.
        • van Velsen L.
        • van Limburg M.
        • de Jong N.
        • Karreman J.
        • Hendrix R.
        • et al.
        Participatory eHealth development to support nurses in antimicrobial stewardship.
        BMC Med Inform Decis Mak. 2014; 14: 1-12https://doi.org/10.1186/1472-6947-14-45
        • Wentzel J.
        • van Drie-Pierik R.
        • Nijdam L.
        • Geesing J.
        • Sanderman R.
        • van Gemert-Pijnen J.E.
        Antibiotic information application offers nurses quick support.
        Am J Infect Control. 2016; 44: 677-684https://doi.org/10.1016/j.ajic.2015.12.038
        • Chow A.L.
        • Lye D.C.
        • Arah O.A.
        Patient and physician predictors of patient receipt of therapies recommended by a computerized decision support system when initially prescribed broad-spectrum antibiotics: a cohort study.
        J Am Med Inform Assoc. 2016; 23: e58-70https://doi.org/10.1093/jamia/ocv120
        • Chow A.
        • Lye D.C.B.
        • Arah O.A.
        Psychosocial determinants of physicians' acceptance of recommendations by antibiotic computerised decision support systems: a mixed methods study.
        Int J Antimicrob Agents. 2015; 45: 295-304https://doi.org/10.1016/j.ijantimicag.2014.10.009
        • Broom J.
        • Broom A.
        • Plage S.
        • Adams K.
        • Post J.J.
        Barriers to uptake of antimicrobial advice in a UK hospital: a qualitative study.
        J Hosp Infect. 2016; 93: 418-422https://doi.org/10.1016/j.jhin.2016.03.011
        • Wentzel M.J.
        Keeping an eye on the context: participatory development of eHealth to support clinical practice.
        Universiteit Twente, 2015
        • Oinas-Kukkonen H.
        • Harjumaa M.
        Persuasive systems design: key issues, process model, and system features.
        Commun Assoc Inf Syst. 2009; 24: 28
        • Kesselheim A.S.
        • Cresswell K.
        • Phansalkar S.
        • Bates D.W.
        • Sheikh A.
        Clinical decision support systems could be modified to reduce “alert fatigue” while still minimizing the risk of litigation.
        Health Aff. 2011; 30: 2310-2317https://doi.org/10.1377/hlthaff.2010.1111
        • Gemert-Pijnen J.
        Het totstandkomen en functioneren van infectiepreventieprotocollen. Een onderzoek naar communicatie gestuurd door wet-en regelgeving.
        University of Twente, Enschede, The Netherlands2003
        • Verhoeven F.
        When staff handle staph: user-driven versus expert-driven communication of infection control guidelines.
        University of Twente, Enschede, The Netherlands2009
        • De Jong N.
        • Wentzel J.
        • Kelders S.
        • Oinas-Kukkonen H.
        • van Gemert-Pijnen J.
        User-centered and persuasive design of a web-based registration and monitoring system for healthcare-associated infections in nursing homes.
        in: The sixth international conference on eHealth, telemedicine, and social medicine (eTELEMED 2014) IARIA. 2014