Clinician acceptance of complex clinical decision support systems for treatment allocation of patients with chronic low back pain

Abstract Background The uptake of complex clinical decision support systems (CDSS) in daily practice remains low, despite the proven potential to reduce medical errors and to improve the quality of care. To improve successful implementation of a complex CDSS this study aims to identify the factors that hinder, or alleviate the acceptance of, clinicians toward the use of a complex CDSS for treatment allocation of patients with chronic low back pain. Methods We tested a research model in which the intention to use a CDSS by clinicians is influenced by the perceived usefulness; this usefulness, in turn is influenced by the perceived service benefits and perceived service risks. An online survey was created to test our research model and the data was analysed using Partial Least Squares Structural Equation Modelling. The study population consisted of clinicians. The online questionnaire started with demographic questions and continued with a video animation of the complex CDSS followed by the set of measurement items. The online questionnaire ended with two open questions enquiring the reasons to use and not use, a complex CDSS. Results Ninety-eight participants (46% general practitioners, 25% primary care physical therapists, and 29% clinicians at a rehabilitation centre) fully completed the questionnaire. Fifty-two percent of the respondents were male. The average age was 48 years (SD ± 12.2). The causal model suggests that perceived usefulness is the main factor contributing to the intention to use a complex CDSS. Perceived service benefits and risks are both significant antecedents of perceived usefulness and perceived service risks are affected by the perceived threat to autonomy and trusting beliefs, particularly benevolence and competence. Conclusions To improve the acceptance of complex CDSSs it is important to address the risks, but the main focus during the implementation phase should be on the expected improvements in patient outcomes and the overall gain for clinicians. Our results will help the development of complex CDSSs that fit more into the daily clinical practice of clinicians.

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Clinician Acceptance of Complex Clinical Decision Support Systems for Treatment Allocation of Patients with Chronic Low Back Pain.

10.21203/rs.3.rs-140940/v1 ◽

2021 ◽

Author(s):

Stephanie Jansen-Kosterink ◽

Lex van Velsen ◽

Miriam Cabrita

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Decision Support Systems ◽

Clinical Decision ◽

Perceived Usefulness ◽

Intention To Use ◽

Low Back ◽

Research Model ◽

Online Questionnaire ◽

Treatment Allocation

Abstract Background: The uptake of complex clinical decision support systems (CDSS) in daily practice remains low, despite the proven potential to reduce medical errors and to improve the quality of care. To improve successful implementation of a complex CDSS service, the aim of this study is to identify the factors that hinder or alleviate the acceptance of clinicians toward the use of a complex CDSS for treatment allocation of patients with chronic low back pain. Methods: We tested a research model in which the intention to use a CDSS by clinicians is influenced by the perceived usefulness; this usefulness, on its turn is influenced by the perceived service benefits and perceived service risks. An online survey was created to test our research model and the data was analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). The study population consisted of clinicians. The online questionnaire started with demographic questions and continued with an animation of the CDSS followed by the set of measurement items. The online questionnaire ended with two open questions enquiring the reasons to use, and not to use, a complex CDSS.Results: Ninety-eight participants (46% general practitioners, 25% primary care physical therapists, and 29% clinicians at a rehabilitation centre) fully completed the questionnaire. Fifty-two percent of the respondents were male. The average age was 48 years (SD±12.2). The causal model suggests that perceived usefulness is the main factor contributing to the intention to use a complex CDSS. Perceived service benefits and risks are both significant antecedents of perceived usefulness and Perceived service risks are affected by the perceived threat to autonomy and trusting beliefs, particularly benevolence and competence.Conclusions: To improve the acceptance of complex CDSSs it is important to address the risks, but the main focus during the implementation phase should be on the expected improvements in patient outcomes and the overall gain for clinicians. Our results will help the developers of complex CDSSs to develop a CDSS that fits more into the daily clinical practice of clinicians.

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The acceptance of clinical decision support systems among clinicians in the treatment of neck and/or back pain

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1234 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S M Jansen-Kosterink ◽

M Cabrita ◽

I Flierman

Keyword(s):

Back Pain ◽

Decision Support ◽

Focus Groups ◽

Decision Support Systems ◽

Clinical Decision Support ◽

Support Systems ◽

Clinical Decision Support Systems ◽

Clinical Decision ◽

Case Based Reasoning ◽

Online Questionnaire

Abstract Background Clinical Decision Support Systems (CDSSs) are computerized systems using case-based reasoning to assist clinicians in making clinical decisions. Despite the proven added value to public health, the implementation of CDSS clinical practice is scarce. Particularly, little is known about the acceptance of CDSS among clinicians. Within the Back-UP project (Project Number: H2020-SC1-2017-CNECT-2-777090) a CDSS is developed with prognostic models to improve the management of Neck and/or Low Back Pain (NLBP). Therefore, the aim of this study is to present the factors involved in the acceptance of CDSSs among clinicians. Methods To assess the acceptance of CDSSs among clinicians we conducted a mixed method analysis of questionnaires and focus groups. An online questionnaire with a low-fidelity prototype of a CDSS (TRL3) was sent to Dutch clinicians aimed to identify the factors influencing the acceptance of CDSSs (intention to use, perceived threat to professional autonomy, trusting believes and perceived usefulness). Next to this, two focus groups were conducted with clinicians addressing the general attitudes towards CDSSs, the factors determining the level of acceptance, and the conditions to facilitate use of CDSSs. Results A pilot-study of the online questionnaire is completed and the results of the large evaluation are expected spring 2020. Eight clinicians participated in two focus groups. After being introduced to various types of CDSSs, participants were positive about the value of CDSS in the care of NLBP. The clinicians agreed that the human touch in NLBP care must be preserved and that CDSSs must remain a supporting tool, and not a replacement of their role as professionals. Conclusions By identifying the factors hindering the acceptance of CDSSs we can draw implications for implementation of CDSSs in the treatment of NLBP.

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Prediction of Treatment Outcomes for Patients with Chronic Low Back Pain: the Development of a Clinical Decision Guideline for Spine Surgeons

Global Spine Journal ◽

10.1055/s-0036-1582716 ◽

2016 ◽

Vol 6 (1_suppl) ◽

pp. s-0036-1582716-s-0036-1582716

Author(s):

Miranda Van Hooff ◽

Hanneke Van Dongen ◽

Maarten Spruit ◽

Raymond Ostelo ◽

Marinus De Kleuver

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Treatment Outcomes ◽

Chronic Low Back Pain ◽

Clinical Decision ◽

Low Back

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Development of a clinical decision support tool for diagnostic imaging use in patients with low back pain: a study protocol

Diagnostic and Prognostic Research ◽

10.1186/s41512-019-0047-8 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Jill A. Hayden ◽

Rachel Ogilvie ◽

Samuel Alan Stewart ◽

Simon French ◽

Samuel Campbell ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Decision Support ◽

Diagnostic Imaging ◽

Clinical Decision Support ◽

Decision Support Tool ◽

Clinical Decision ◽

Low Back ◽

Support Tool ◽

Clinical Decision Support Tool

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P086: Effectiveness of interventions to decrease imaging among emergency department low back pain presentations: a systematic review

CJEM ◽

10.1017/cem.2017.288 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S107

Author(s):

C. Lui ◽

S. Desai ◽

L. Krebs ◽

S.W. Kirkland ◽

D. Keto-Lambert ◽

...

Keyword(s):

Emergency Department ◽

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Grey Literature ◽

Clinical Decision ◽

Unintended Consequences ◽

Relative Reduction ◽

Significant Heterogeneity ◽

Low Back

Introduction: Low back pain (LBP) is an extremely frequent emergency department (ED) presentation. Although LBP imaging often results in no change to the ED management, does not identify abnormalities, and has documented risks (e.g., radiation exposure), advanced imaging (i.e., computed tomography [CT], magnetic resonance imaging [MRI]) for patients with LBP has become increasingly frequent in the ED. The objective of this review was to identify and examine the effectiveness and safety of interventions aimed at reducing imaging in the ED for LBP patients. Methods: Six bibliographic databases and grey literature were searched. Comparative studies assessing interventions aimed at reducing ED imaging for adult patients with LBP were eligible for inclusion. Two reviewers independently screened study eligibility, completed data extraction, and assessed the quality of included studies. Due to a limited number of studies and significant heterogeneity, a descriptive analysis was performed. Results: The search yielded 510 unique citations of which three before-after studies were included. Quality assessment identified potential biases relating to comparability between the pre- and post-intervention groups, reliable assessment of outcomes, and an overall lack of information on the intervention (i.e., time point, description, intervention data collection). The interventions to reduce lumbar spine imaging varied considerably. Study interventions included: 1) clinical decision support (i.e., a specialized X-ray requisition form), which reported a 47.4% relative reduction of lumbar spine radiography referrals; 2) clinical decision guidelines, which reduced referrals by 43.8%; and 3) multidisciplinary protocols, which reported a reduction in the MRI referral rate by 26.1%. Despite reductions in simple imaging, CT use increased in two of the three studies. Conclusion: LBP has been identified as a key area of imaging overuse (e.g., Choosing Wisely recommendation). Yet, evidence of interventions’ effectiveness in reducing imaging for ED patients with LBP is sparse. While there is some evidence to suggest that interventions can reduce the use of simple imaging in LBP in the ED, unintended consequences have been reported and additional studies employing higher quality methods are strongly recommended.

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