TY - JOUR
T1 - An evaluation of the Veterans Health Administration's clinical reminders system
T2 - A national survey of generalists
AU - Fung, Constance H.
AU - Tsai, Jerry S.
AU - Lulejian, Armine
AU - Glassman, Peter
AU - Patterson, Emily
AU - Doebbeling, Brad N.
AU - Asch, Steven M.
N1 - Funding Information:
Acknowledgements: The authors are grateful to Barbara Simon, MA for her assistance with the survey, Mingming Wang, MPH for her assistance in programming the facility data, and Joya Golden for her administrative support of the project. This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (TRX 02-216). A VA HSR&D Advanced Career Development Award supported Dr. Asch, and a VA HSR&D Merit Review Entry Program Award supported Dr. Patterson. The views expressed in this article are those of the authors and do not necessarily represent the view of the Department of Veterans Affairs.
PY - 2008/4
Y1 - 2008/4
N2 - BACKGROUND: The Veterans Health Administration (VHA) is a leader in developing computerized clinical reminders (CCRs). Primary care physicians' (PCPs) evaluation of VHA CCRs could influence their future development and use within and outside the VHA. OBJECTIVE: Survey PCPs about usefulness and usability of VHA CCRs. DESIGN AND PARTICIPANTS: In a national survey, VHA PCPs rated on a 7-point scale usefulness and usability of VHA CCRs, and standardized scales (0-100) were constructed. A hierarchical linear mixed (HLM) model predicted physician- and facility-level variables associated with more positive global assessment of CCRs. RESULTS: Four hundred sixty-one PCPs participated (response rate, 69%). Scale Cronbach's alpha ranged from 0.62 to 0.82. Perceptions of VHA CCRs were primarily in the midrange, where higher ratings indicate more favorable attitudes (weighted standardized median, IQR): global assessment (50, 28-61), clinical/situational specificity (29, 17-42), integration with workflow/workload (39, 17-50), training (50, 33-67), VHA's management of CCR use (67, 50-83), design/interface (53, 40-67), perceived role in CCR use (67, 50-83), and self-efficacy (67, 57-78). In a HLM model, design/interface (p<.001), self-efficacy (p<.001), integration with workflow/workload (p<.001), and training (p<.001) were associated with more favorable global assessments of CCRs. Facilities in the west as compared to the south (p=.033), and physicians with academic affiliation (p=.045) had less favorable global assessment of CCRs. CONCLUSIONS: Our systematic assessment of end-users' perceptions of VHA CCRs suggests that CCRs need to be developed and implemented with a continual focus on improvement based on end-user feedback. Potential target areas include better integration into the primary care clinic workflow/workload.
AB - BACKGROUND: The Veterans Health Administration (VHA) is a leader in developing computerized clinical reminders (CCRs). Primary care physicians' (PCPs) evaluation of VHA CCRs could influence their future development and use within and outside the VHA. OBJECTIVE: Survey PCPs about usefulness and usability of VHA CCRs. DESIGN AND PARTICIPANTS: In a national survey, VHA PCPs rated on a 7-point scale usefulness and usability of VHA CCRs, and standardized scales (0-100) were constructed. A hierarchical linear mixed (HLM) model predicted physician- and facility-level variables associated with more positive global assessment of CCRs. RESULTS: Four hundred sixty-one PCPs participated (response rate, 69%). Scale Cronbach's alpha ranged from 0.62 to 0.82. Perceptions of VHA CCRs were primarily in the midrange, where higher ratings indicate more favorable attitudes (weighted standardized median, IQR): global assessment (50, 28-61), clinical/situational specificity (29, 17-42), integration with workflow/workload (39, 17-50), training (50, 33-67), VHA's management of CCR use (67, 50-83), design/interface (53, 40-67), perceived role in CCR use (67, 50-83), and self-efficacy (67, 57-78). In a HLM model, design/interface (p<.001), self-efficacy (p<.001), integration with workflow/workload (p<.001), and training (p<.001) were associated with more favorable global assessments of CCRs. Facilities in the west as compared to the south (p=.033), and physicians with academic affiliation (p=.045) had less favorable global assessment of CCRs. CONCLUSIONS: Our systematic assessment of end-users' perceptions of VHA CCRs suggests that CCRs need to be developed and implemented with a continual focus on improvement based on end-user feedback. Potential target areas include better integration into the primary care clinic workflow/workload.
KW - Decision support systems clinical
KW - Evidence-based medicine
KW - Medical records systems computerized
KW - Primary health care
KW - Quality of health care
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U2 - 10.1007/s11606-007-0417-8
DO - 10.1007/s11606-007-0417-8
M3 - Article
C2 - 18373135
AN - SCOPUS:41549135617
SN - 0884-8734
VL - 23
SP - 392
EP - 398
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 4
ER -