Designing User-Centered Decision Support Tools for Chronic Pain in Primary Care (Indiana)

Project Details - Ongoing

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While millions of Americans suffer from chronic pain, negatively impacting health care costs and lost worker productivity, most providers receive little training in pain care. The use of decision support tools, such as computerized alerts or checklists within electronic health records (EHRs), has the potential to improve pain care. However, to be effective, decision support must be designed based on a detailed understanding of how clinicians’ use information to understand patients’ conditions, i.e., clinical sensemaking. Therefore, research is needed to characterize clinical work environments, information needs and use, and decisionmaking. Such research is especially relevant to chronic noncancer pain in primary care, where clinicians often report dissatisfaction and uncertainty when managing patients.

The overall goal of this project is to develop decision support tools that integrate with EHRs to increase the quality and effectiveness of chronic pain care. The specific aims of the project are as follows:

  • Characterize primary care clinicians’ information use and decisionmaking patterns during patient visits for musculoskeletal pain to determine how they align with clinical practice guidelines
  • Prototype and preliminarily evaluate new decision support designs to meet clinicians’ information needs and guide them toward guideline-based information use and care choices

For the first aim, data will be collected from medical records, visit audio recordings, and post-visit clinician interviews for up to 125 patient visits. This data will be analyzed to cluster visits into similar sensemaking narratives and used to identify common missed opportunities in which decision support could have altered the use of clinical information or altered care plan choices to better align with guideline recommendations. The project team will then conduct a design workshop and usability testing to produce prototypes for guideline-based decision support systems that can be integrated in EHRs.

This research will improve understanding of how primary care clinicians access and use patient information to provide the best possible care for patients with chronic pain. With this knowledge, this study will develop new information technology tools that help physicians make evidence-based care decisions and improve the lives of Americans who suffer from chronic pain.

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