Evidence map›Paper›PMID 39302103›Full record

ArticleJournal of the American Medical Informatics Association : JAMIA2024

Exploring home healthcare clinicians' needs for using clinical decision support systems for early risk warning.

Zidu Xu, Lauren Evans, Jiyoun Song, Sena Chae, Anahita Davoudi, Kathryn H Bowles, Margaret V McDonald, Maxim Topaz

Abstract read
In one paragraph

Article in Journal of the American Medical Informatics Association : JAMIA, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Zidu XuSchool of Nursing, Columbia University, New York, NY 10032, United States.ORCID 0000-0002-6122-8426
Lauren EvansCenter for Home Care Policy & Research, VNS Health, New York, NY 10017, United States.
Jiyoun SongSchool of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States.ORCID 0000-0003-0362-0670
Sena ChaeCollege of Nursing, The University of Iowa, Iowa City, IA 52242, United States.ORCID 0000-0002-9136-6176
Anahita DavoudiCenter for Home Care Policy & Research, VNS Health, New York, NY 10017, United States.
Kathryn H BowlesCenter for Home Care Policy & Research, VNS Health, New York, NY 10017, United States.
Margaret V McDonaldCenter for Home Care Policy & Research, VNS Health, New York, NY 10017, United States.
Maxim TopazSchool of Nursing, Columbia University, New York, NY 10032, United States.ORCID 0000-0002-2358-9837

Funding

Viral VectorP30CA086862 · NCI · UNIVERSITY OF IOWA · PI Jon C.D. Houtman · 2000 to 2026
$70.0M
Homecare-CONCERN: Building risk models for preventable hospitalizations and emergency department visits in homecareR01HS027742 · AHRQ · VISITING NURSE SERVICE OF NEW YORK · PI TOPAZ, MAXIM · 2020 to 2023
$1.5M
AHRQ HHS R01 HS027742
6 · The paper itself

Abstract

objectivesTo explore home healthcare (HHC) clinicians' needs for Clinical Decision Support Systems (CDSS) information delivery for early risk warning within HHC workflows.

methodsGuided by the CDS "Five-Rights" framework, we conducted semi-structured interviews with multidisciplinary HHC clinicians from April 2023 to August 2023. We used deductive and inductive content analysis to investigate informants' responses regarding CDSS information delivery.

resultsInterviews with thirteen HHC clinicians yielded 16 codes mapping to the CDS "Five-Rights" framework (right information, right person, right format, right channel, right time) and 11 codes for unintended consequences and training needs. Clinicians favored risk levels displayed in color-coded horizontal bars, concrete risk indicators in bullet points, and actionable instructions in the existing EHR system. They preferred non-intrusive risk alerts requiring mandatory confirmation. Clinicians anticipated risk information updates aligned with patient's condition severity and their visit pace. Additionally, they requested training to understand the CDSS's underlying logic, and raised concerns about information accuracy and data privacy. DISCUSSION: While recognizing CDSS's value in enhancing early risk warning, clinicians highlighted concerns about increased workload, alert fatigue, and CDSS misuse. The top risk factors identified by machine learning algorithms, especially text features, can be ambiguous due to a lack of context. Future research should ensure that CDSS outputs align with clinical evidence and are explainable.

conclusionThis study identified HHC clinicians' expectations, preferences, adaptations, and unintended uses of CDSS for early risk warning. Our findings endorse operationalizing the CDS "Five-Rights" framework to optimize CDSS information delivery and integration into HHC workflows.

Indexed as

Decision Support Systems, ClinicalHome Care ServicesAttitude of Health PersonnelElectronic Health RecordsFemaleHumansInterviews as TopicMaleRisk Assessmentdecision support systemshome healthcarenursing informaticsuser-friendly interfaceworkflow integration

Identifiers

PMID39302103
PMCPMC11491664

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.