Clinical practice guideline-related knowledge representation models and comprehension-generated inferences of nurse practitioners and physicians at varying levels of expertise

Clinical practice guidelines (CPGs) are intended to provide evidence-based knowledge for decision making for patient care. However, these guidelines have been poorly adopted by healthcare providers. One reason for this may be the static paper-based formats, isolated from the point of care. Biomedical informatics has provided a solution to this limitation through Computer Interpretable Guidelines (CIGs). An essential component of this process is CPG translation to a computer-interpretable model; comprehension of the CPG is a prerequisite to this process. Although physicians and Advanced Practice Nurses (APNs) are both CPG users, in the guideline modeling literature, the CPG translators are typically physicians, suggesting that the models reflect physician comprehension of CPGs. It is not known if APNs and physicians comprehend CPGs similarly and whether CPG comprehension varies by level of expertise. Therefore, this descriptive study utilized novice and expert APN and physician participants (n=12) using a CPG for screening for and treating tobacco use and dependence for a simulated patient task to determine if the comprehended CPG-related knowledge content and structure differed by discipline or by level of expertise (novice and expert). Methods. After gathering demographic data from each participant, Think Aloud technique was employed to obtain verbal protocols as data. This data set was derived as the participant was thinking aloud while using the study CPG to plan care for a simulated patient. After planning the simulated patient's care, each participant drew a representative model of the study CPG from recall. Methods of analysis for the verbal protocol data set included protocol, discourse, and content analyses. Structural and content analyses were employed for the examination of the recalled drawings. Results. The results of this study are derived from the examination of comprehension activity types, comprehension-generated inferences of knowledge content and structure made during the study task, and recall of the study CPG knowledge content and structure after completing the study task. The results indicate similarities and differences in the comprehension of the study CPG between the participants, grouped by discipline and level of expertise. The disciplines similarly employed types of comprehension activities during the study task. The disciplines differed in their comprehension-generated inferences of knowledge content; the physicians inferred more content during the study task. (Abstract shortened by UMI.)...