Applying Clinician Macrocognition in Designing a Clinical Decision Support Tool for Congenital Heart Disease
Bibliographic record
Abstract
Introduction: When presenting to the emergency department (ED), children with congenital heart disease (CHD) experience higher rates of hospital admission, morbidity, and mortality compared to children without CHD. The burden of residual lesions and the natural history of many CHDs predisposes these children to hemodynamic fragility and altered response to traditional resuscitative measures. Their optimal outcome requires CHD-expertise which is limited in local EDs. Hence, there is an urgent need for a sociotechnical solution to support the evaluation, diagnosis, and management of these patients in ED. Three studies address this need by contributing to the development and evaluation of a clinical decision support system (CDSS) based on the cognitive work of CHD-experts and ED physicians. Methods: In study 1, using the critical decision method, a cognitive task analysis (CTA) of CHD-experts and ED physicians was conducted to understand differences in their macrocognition when managing acutely ill pediatric CHD patients. In study 2, decision centered design was used to identify key decision requirements and design concepts to inform the prototype CDSS. In study 3, scenario-based simulation was used to test the effect of the CDSS on ED physicians’ decision making. Results: The most pertinent differences in decision making between CHD-experts and ED physicians were in sensemaking, anticipation, and managing complexity. Accordingly, the key decision requirements and design concepts incorporated into the prototype CDSS included appreciating the CHD physiology, identifying CHD-specific diagnoses, and selecting appropriate CHD interventions. The use of the CDSS significantly improved ED physicians’ CHD-specific decision-making (M=5.43, 95%CI 3.7-7.2) compared to usual care. Conclusion: These studies reveal differences in CHD-expert and ED physicians’ macrocognition and decision making while also proposing a design approach to develop and evaluate a CHD-specific CDSS. Results and methods presented here can be used by clinicians, developers, and researchers to design sociotechnical solutions beyond pediatric CHD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.062 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".