Usability evaluation of a clinical decision support tool for osteoporosis disease management

David Newton,Monika Kastner,Danielle Lottridge,Christine Marquez,Sharon E Straus

doi:10.1186/1748-5908-5-96

David Newton, Monika Kastner + Show 3 more

Open Access

https://doi.org/10.1186/1748-5908-5-96

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Abstract

BackgroundOsteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines are available, patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions and a series of focus groups were used to develop a functional multifaceted tool that can support clinical decision-making in osteoporosis disease management at the point of care. The objective of our study was to assess how well the prototype met functional goals and usability needs.MethodsWe conducted a usability study for each component of the tool--the Best Practice Recommendation Prompt (BestPROMPT), the Risk Assessment Questionnaire (RAQ), and the Customised Osteoporosis Education (COPE) sheet--using the framework described by Kushniruk and Patel. All studies consisted of one-on-one sessions with a moderator using a standardised worksheet. Sessions were audio- and video-taped and transcribed verbatim. Data analysis consisted of a combination of qualitative and quantitative analyses.ResultsIn study 1, physicians liked that the BestPROMPT can provide customised recommendations based on risk factors identified from the RAQ. Barriers included lack of time to use the tool, the need to alter clinic workflow to enable point-of-care use, and that the tool may disrupt the real reason for the visit. In study 2, patients completed the RAQ in a mean of 6 minutes, 35 seconds. Of the 42 critical incidents, 60% were navigational and most occurred when the first nine participants were using the stylus pen; no critical incidents were observed with the last six participants that used the touch screen. Patients thought that the RAQ questions were easy to read and understand, but they found it difficult to initiate the questionnaire. Suggestions for improvement included improving aspects of the interface and navigation. The results of study 3 showed that most patients were able to understand and describe sections of the COPE sheet, and all considered discussing the information with their physicians. Suggestions for improvement included simplifying the language and improving the layout.ConclusionsFindings from the three studies informed changes to the tool and confirmed the importance of usability testing on all end users to reduce errors, and as an important step in the development process of knowledge translation interventions.

Highlights

Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems
The resulting prototype tool is targeted to both physicians and patients and consists of three components: (1) an electronic osteoporosis Risk Assessment Questionnaire (RAQ) completed by eligible patients on a tablet PC in the clinic examination room; (2) a paper-based, Best Practice Recommendation Prompt (BestPROMPT) outlining appropriate osteoporosis disease-management recommendations for use by physicians at the point of care; and (3) a paper-based, Customised Osteoporosis Educational (COPE) sheet given to patients at the end of their physician visit
Once the questionnaire is completed, RAQ responses are processed using a decision algorithm programmed into the tablet PC, which automatically generates two paper-based outputs using a wireless printer: one for the physician and one for the patient

Summary

Introduction

Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. The resulting prototype tool is targeted to both physicians and patients and consists of three components: (1) an electronic osteoporosis Risk Assessment Questionnaire (RAQ) completed by eligible patients on a tablet PC in the clinic examination room; (2) a paper-based, Best Practice Recommendation Prompt (BestPROMPT) outlining appropriate osteoporosis disease-management recommendations for use by physicians at the point of care; and (3) a paper-based, Customised Osteoporosis Educational (COPE) sheet given to patients at the end of their physician visit. The BestPROMPT provides a summary of the patient’s RAQ responses, a section outlining appropriate osteoporosis diseasemanagement recommendations (e.g., to initiate bone mineral density testing or osteoporosis medications such as bisphosphonates), and a graph to plot the patient’s 10-year absolute fracture risk These features were designed so that physicians would be able to use this information with their patients at the point of care. The COPE sheet summarizes patients’ osteoporosis risks according to their RAQ responses and provides a section outlining osteoporosis information customised to their identified risks (i.e., an explanation of what each risk factors means, and what they can do about them)

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