CASE STUDIES

Training for Use of Clinical Decision Support Tools

ACI-TIPI

The Problem

The Division of Clinical Care Research at the New England Medical Center of Tufts University developed an informatics tool called the ACI-TIPI (Acute Cardiac Ischemia Time-Insensitive Predictive Instrument), which was aimed at helping clinicians make decisions about cardiac diagnoses and admissions. Informatics tools such as this have tremendous potential for improving the quality of health care and enhancing patient safety. Indeed, the ACI-TIPI tool itself had demonstrated statistical validity and clinical effectiveness. However, it had seen only limited adoption and use in medical centers around the country. Tufts University asked Aptima to help develop a study to understand why this and other informatics tools were not being used more widely.

The Solution

Working with the university, Aptima conducted a study to understand the reasons underlying the limited use of medical decision-support tools and to explore the potential of a computer-based tutorial to reduce barriers to use.

Aptima’s study focused on several issues: identifying “barriers” to the acceptance and use of the ACI-TIPI by clinicians; understanding how they use information in making ACI diagnoses and admissions decisions; and learning to what extent they use the ACI-TIPI score in their decision process and what factors if any prevent them from using the score.

To accomplish this task, Aptima combined a structured interview process – called Cognitive Task Analysis – with the repeated use of pre-designed representative cases as one might do in a controlled experiment. In addition, Aptima developed and tested the effectiveness of a brief web-based “demystifying” tutorial aimed at removing the barriers to using the ACI-TIPI. A sample of physicians from Tufts-New England Medical Center completed the tutorial and were interviewed afterwards about their diagnostic decision processes and their understanding and use of the ACI-TIPI.

ACI-TIPI

The Results

The Web-based tutorial product was found to have a significant effect on many of the barriers to acceptance and use of the ACI-TIPI. Physicians who had completed the tutorial were more aware of the ACI-TIPI score and reported taking the score into consideration more often in their decisions.

A critical finding of the study was that in as little as ten minutes, a tutorial can present enough information to significantly change confidence and perceptions about this kind of tool, resulting in increased acceptance and use of decision support tools for medical diagnosis.

These findings have implications beyond the ACI-TIPI, and can be applied to medical decision-support instruments and design methods in a multitude of medical domains.