Rationalising the use of clinical decision support systems

Do you want to address the critical gap between evidence and practice? Do you want to do cutting-edge research with interdisciplinary supervisors and develop a career as an implementation scientist? If so, this studentship opportunity will appeal to you.<br /> <br /> One full scholarship is available in the School of Medicine. This fully funded PhD place provides an exciting opportunity to pursue postgraduate research in patient safety and implementation science, with a strong emphasis on understanding and changing clinician behaviour.<br /> <br /> The School of Medicine invites applications from prospective postgraduate researchers who wish to commence study for a PhD in the academic year 2023/24 for an NIHR Yorkshire and Humber Patient Safety Research Collaboration (PSRC) Scholarship.<br /> <br /> The award is open to full-time or part-time candidates (UK only) who meet the eligibility for a place on a PhD degree at the School of Medicine. We especially welcome applications that connect to the School's core research areas, which are patient safety, implementation science and complex interventions.

<p>The growing complexity of health care, the demands of managing multi-morbidity,[1] and increasing availability of clinical guidelines [2] all contribute to pressures on clinical decision-making. There is ample evidence of failures to deliver recommended care and protect patients from harm. For example, an economic evaluation of the prevalence and burden of medication errors estimated that prescribing in primary care accounts for 34% of all potentially clinically significant medication errors in the NHS, costing &pound;83.7&thinsp;million and causing 627 deaths per annum.[3]</p> <p>Clinical decision support systems (CDSSs) aim to improve safety by reminding clinicians to deliver recommended care and reducing errors in decision-making. They may include relatively sophisticated clinical decision support systems linked to patient-specific information. They are relatively inexpensive to implement and can be rapidly scaled up within electronic health record systems. They are ubiquitous in primary and secondary care electronic health record systems. A systematic review of 108 studies of CDSSs suggests that their modest benefits on clinical practice [4] may not always outweigh unintended consequences, such as alert fatigue, distraction, de-railing patient agendas during consultations, and even clinician burnout.[5, 6] For example, clinicians are prone to ignore or discount multiple hazards highlighted in prescribing safety alerts, especially as alerts typically appear after they have made decisions to prescribe.</p> <p>System features and clinical contexts poorly accounted for strikingly variable effects in the review, prompting the conclusion that current literature &lsquo;provides little guidance for identifying the circumstances under which CDSS interventions produce worthwhile improvements in care.&rsquo;[4] There is therefore a need for work to elaborate CDSS&nbsp;features which may make them effective or not, and offer guidance on which CDSSs can be withdrawn without compromising patient safety. Such work needs to build upon a growing body of literature which highlights the importance of integrating digital innovations such as CDSSs within evolving systems and clinical workflows.[7-9]</p> <p>This PhD studentship will focus on the development of a practical, generalizable framework defining the desirable key features of CDSSs and the contexts (settings, targeted safety behaviours) for which they are most likely to be effective or not. This framework will draw upon human factors, and in particular behavioural change theory and cognitive psychology. The initial work of this studentship will be based on a systematic review and metasynthesis of qualitative studies evaluating CDSSs. Further work may then include an analysis of CDSSs commonly used in practice and user-centred design of a suite of exemplar patient safety CDSSs (e.g. prescribing, safety netting).</p> <p>The outputs of this studentship will include (i) a practical framework and set of principles for the re-design or de-commissioning of CDSSs for patient safety and (ii) illustrations of CDSS features that are likely to be redundant or disruptive to patient safety.&nbsp;It is expected that the candidate will develop methodological skills in systematic reviewing of qualitative studies and user-centred design as well as specialist knowledge in behaviour change and implementation science.</p> <h4>Environment</h4> <p>The studentship will be based across the <a href="https://medicinehealth.leeds.ac.uk/homepage/146/leeds_institute_of_health_science">Leeds Institute of Health Sciences</a> and <a href="https://medicinehealth.leeds.ac.uk/psychology">School of Psychology</a>, both at the University of Leeds, the <a href="https://www.bradfordresearch.nhs.uk/">Bradford Institute for Health Research</a> and the Faculty of Health, University of Bradford. YH PSRC PhD students will become NIHR trainees and you will benefit from a range of training support and resources to develop your knowledge and health research skills. You will also be embedded within the <a href="https://yqsr.org/">Yorkshire Quality and Safety Research Group</a>,&nbsp;which is a friendly and dynamic group of researchers conducting high-quality, rigorous and applied research to develop and evaluate innovative solutions to patient safety problems.</p> <p><a href="https://yhpsrc.org/">YH PSRC</a> is a collaboration between the Bradford Teaching Hospitals Foundation Trust and the Universities of Leeds and Bradford. Our mission is to deliver research to make healthcare safer. We are one of six NIHR Patient Safety Research Collaborations in England. Our work draws on the knowledge and expertise of well-established networks of researchers, patients, carers, clinicians and industry partners to develop ideas that address patient safety problems. &nbsp;</p> <p>Our research focusses on four themes: Safer systems, culture and practice; De-cluttering (safely) for safety; Supporting safe care in the home; and Rethinking safety intelligence for improvement.</p> <p>The studentship will also be linked to the Leeds Unit for Complex Intervention Development (<a href="https://medicinehealth.leeds.ac.uk/directory_record/1238/leeds-unit-for-complex-intervention-development-lucid">LUCID</a>), a methodological research group based across LIHS and the Leeds Institute for Clinical Trials Research, focused on developing and optimising complex healthcare interventions to improve patient and public outcomes.</p> <h4>Other conditions:</h4> <p>&bull;&nbsp;&nbsp; &nbsp;Applicants must not have already been awarded or be currently studying for a doctoral degree.<br /> &bull;&nbsp;&nbsp; &nbsp;Awards must be taken up by 1st October 2023.<br /> &bull;&nbsp;&nbsp; &nbsp;Applicants must live within a reasonable distance of the University of Leeds whilst in receipt of this scholarship.</p> <p>References:</p> <p>1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012, 380(9836):37-43.<br /> 2. Rushforth B, Stokes T, Andrews E, Willis TA, McEachan R, Faulkner S, Foy R: Developing &#39;high impact&#39; guideline-based quality indicators for UK primary care: a multi-stage consensus process. BMC Fam Pract 2015, 16(1):156.<br /> 3. Elliott RA, Camacho E, Jankovic D, Sculpher MJ, Faria R: Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Qual Saf 2021, 30(2):96-105.<br /> 4. Kwan JL, Lo L, Ferguson J, Goldberg H, Diaz-Martinez JP, Tomlinson G, Grimshaw JM, Shojania KG: Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials. 2020, 370:m3216.<br /> 5. Jani YH, Franklin BD: Interruptive alerts: only one part of the solution for clinical decision support. BMJ Quality &amp;amp; Safety 2021, 30(12):933-936.<br /> 6. Downing NL, Bates DW, Longhurst CA: Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause? Ann Intern Med 2018, 169(1):50-51.<br /> 7. Ford E, Edelman N, Somers L, Shrewsbury D, Lopez Levy M, van Marwijk H, Curcin V, Porat T: Barriers and facilitators to the adoption of electronic clinical decision support systems: a qualitative interview study with UK general practitioners. BMC medical informatics and decision making 2021, 21(1):193.<br /> 8. Porat T, Delaney B, Kostopoulou O: The impact of a diagnostic decision support system on the consultation: perceptions of GPs and patients. BMC medical informatics and decision making 2017, 17(1):79.<br /> 9. Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A&#39;Court C, Hinder S, Fahy N, Procter R, Shaw S: Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. J Med Internet Res 2017, 19(11):e367.</p>

<p>To apply for this scholarship opportunity applicants should complete an <a href="https://biologicalsciences.leeds.ac.uk/research-degrees/doc/how-to-apply">online application form</a> and attach the following documentation to support their application.&nbsp;</p> <ul> <li>a full academic CV</li> <li>degree certificate and transcripts of marks</li> <li>Evidence that you meet the University&#39;s minimum English language requirements (if applicable)</li> </ul> <p>To help us identify that you are applying for this scholarship project please ensure you provide the following information on your application form;</p> <ul> <li>Select PhD in Healthcare as your programme of study</li> <li>Give the full project title and name the supervisors listed in this advert</li> <li>For source of funding please state you are applying for an NIHR Scholarship</li> </ul> <p>If English is not your first language, you must provide evidence that you meet the University&#39;s minimum English language requirements (below).</p> <p><em>As an international research-intensive university, we welcome students from all walks of life and from across the world. We foster an inclusive environment where all can flourish and prosper, and we are proud of our strong commitment to student education. Across all Faculties we are dedicated to diversifying our community and we welcome the unique contributions that individuals can bring, and particularly encourage applications from, but not limited to Black, Asian, people who belong to a minority ethnic community, people who identify as LGBT+ and people with disabilities. Applicants will always be selected based on merit and ability.</em></p>

Applicants to this scholarship in the School of Medicine should normally have an Undergraduate degree of 2:1 or above (or international equivalent) in a relevant subject area such as a health-related subject (e.g. pharmacy, nursing etc.), psychology or social science. A Master&rsquo;s degree is desirable, but not essential. Applicants who are uncertain about the requirements for a particular research degree are advised to contact the School or Admissions Team prior to making an application.

Applicants whose first language is not English must provide evidence that their English language is sufficient to meet the specific demands of their study. The Faculty of Medicine and Health minimum requirements in IELTS and TOEFL tests for PhD, MSc, MPhil, MD are: &bull; British Council IELTS - score of 6.5 overall, with no element less than 6.0 &bull; TOEFL iBT - overall score of 92 with the listening and reading element no less than 21, writing element no less than 22 and the speaking element no less than 23.

<p>This opportunity is funded by the National Institute of Health Research (NIHR). The scholarship will attract an annual tax-free stipend of &pound;17,668 for year one, and this will increase each year for up to 3 years subject to satisfactory progress. Academic fees will also be paid at the UK fee rate. Due to limited funding we can only consider applicants for this position who are eligible for UK fee status.</p>

<p>For informal enquiries regarding this project please contact Professor Robbie Foy:</p> <p>e: <a href="mailto:r.foy@leeds.ac.uk">r.foy@leeds.ac.uk</a></p> <p>For further information about the application process please contact the Admissions team<br /> e:&nbsp;<a href="mailto:fmhpgradmissions@leeds.ac.uk">fmhpgradmissions@leeds.ac.uk</a></p>