JMIR Publications

ABSTRACT

Background:

Peripheral arterial disease (PAD) is underdiagnosed, partially due to a high prevalence of atypical symptoms and lack of physician and patient awareness. Implementing clinical decision support tools powered by machine learning algorithms may help physicians identify high risk patients for diagnostic workup.

Objective:

The Consolidated Framework for Implementation Research (CFIR) was used to evaluate barriers and facilitators to implementation of a novel machine-learning based screening tool for peripheral arterial disease amongst physician and patient stakeholders.

Methods:

Semi-structured interviews were performed with physicians and patients from the Stanford University Department of Primary Care and Population Health, Division of Cardiology, and Division of Vascular Medicine. Participants answered questions regarding their perceptions towards machine learning and clinical decision support for peripheral arterial disease detection. Rapid thematic analysis was performed using templates incorporating codes from CFIR constructs.

Results:

12 physicians (6 primary care physicians, 6 cardiovascular specialists) and 14 patients were interviewed. Barriers to implementation arose from six CFIR constructs: complexity, evidence strength and quality, relative priority, external policies and incentives, knowledge and beliefs about intervention, and individual identification with organization. Facilitators arose from five CFIR constructs: intervention source, relative advantage, learning climate, patient needs and resources, and knowledge and beliefs about intervention. Physicians felt that a machine learning-powered diagnostic tool for PAD would improve patient care but cited limited time and authority in asking patients to undergo additional screening procedures. Patients were interested in having their physicians use this tool but raised concerns about such technologies replacing human decision-making.

Conclusions:

Patient and physician reported barriers towards the implementation of a machine learning-powered PAD diagnostic tool followed three interdependent themes: (1) Low familiarity or urgency in detecting peripheral arterial disease; (2) Concerns regarding the reliability of machine learning; (3) Differential perceptions of responsibility for PAD care amongst primary care versus specialty physicians; (4) Patient preference for physicians to remain primary interpreters of healthcare data. Facilitators followed two interdependent themes: (A) Enthusiasm for clinical utility of the predictive model; (B) Willingness to incorporate machine learning into clinical care. Implementation of machine learning powered-diagnostic tools for PAD should leverage provider support, while simultaneously educating stakeholders on the importance of early PAD diagnosis. High predictive validity is necessary for machine learning models, but not sufficient for implementation.