Final phase alpha testing of the Self-management TO Prevent (STOP) Stroke Tool®
The Self-management TO Prevent (STOP) Stroke Tool® is a clinical decision support system (CDSS) that directs health care providers in evidence-based secondary prevention for ischemic stroke. The predominant functionality feature of the STOP Stroke Tool® is automated prompting and documentation of secondary stroke prevention clinical practice guidelines (CPGs) in the electronic medical record. Alpha stage development has been completed to develop a fully functional prototype. This study reports results from final phase Alpha testing and introduces an integrated model that emphasizes the end-user perspective to guide the development process. Final phase Alpha testing was focused on two specific aims: (a) to test the intended functionality of each component of the prototype in simulation, and (b) to determine the overall usability of the prototype among a sample of multidisciplinary clinicians. A pre-experimental before/after design and descriptive methods were utilized.
To test functionality, documentation of CPGs was compared among a sample of multidisciplinary providers (N = 15) using test case scenarios and two documentation systems, the standard system vs. the STOP Stroke Tool. Usability was evaluated with an investigator-developed questionnaire and one open-ended question. Nonparametric statistics were used to analyze the data. The prototype prompted a significant increase (p ≤ .05) in providers' documentation for 6 of 11 CPGs (55%) as compared to baseline documentation while using the standard system. Out of a possible 56 points, usability was scored high (M = 48.9, SD = 6.8). No significant differences were found among provider types on total usability scores indicating a consensus for high usability of the tool across all provider types.
Alpha test results demonstrate that CPG prompting has been successfully engineered to produce a usable and useful CDSS for secondary stroke prevention. Further studies will focus on Beta testing the STOP Stroke Tool in multiple 'real-time' clinical practice settings (primary care, neurology, rehabilitation).