Using EHR-Based Clinical Decision Support to Provide Social Risk-Informed Care in Community Health Centers: Study Protocol and Design (Preprint)

2021 ◽  
Author(s):  
Rachel Gold ◽  
Christina Sheppler ◽  
Danielle Hessler ◽  
Arwen Bunce ◽  
Erika Cottrell ◽  
...  
Keyword(s):  
Decision Support ◽  
Health Outcomes ◽  
Clinical Decision Support ◽  
Community Health Centers ◽  
Intervention Group ◽  
Clinical Decision ◽  
Health Centers ◽  
Social Risk ◽  
Social Risks ◽  
Improve Health

BACKGROUND Consistent and compelling evidence demonstrates that social and economic adversity impact health outcomes. In response, many healthcare professional organizations recommend screening patients for experiences of social and economic adversity or ‘social risks’—e.g., food, housing, and transportation insecurity—in the context of care. The guidance on how healthcare providers can act on documented social risk data to improve health outcomes is nascent. One strategy recommended by the National Academy of Medicine involves using social risk data to adapt care plans in ways that accommodate patients’ social risks. OBJECTIVE This study’s aims are to (1) develop electronic health record-based clinical decision support (CDS) tools that suggest social risk-informed care plan adaptations for patients with diabetes and/or hypertension; (2) assess tool adoption and its impact on selected Clinical Quality Measures in community health centers; and (3) examine perceptions of tool usability and impact on care quality. METHODS A systematic scoping review and several stakeholder activities will be conducted to inform development of the CDS tools. The tools will be pilot tested to obtain user input, and their content and form revised based on this input. A randomized quasi-experimental design will then be used to assess the revised tools’ impact. Eligible clinics will be randomized to a control group or potential intervention group; clinics will be recruited from the potential intervention group in a random order until six are enrolled in the study. Intervention clinics will have access to the CDS tools in their EHR, will receive minimal implementation support, and will be followed for 18 months to evaluate tool adoption and the impact of tool use on patient blood pressure and glucose control. RESULTS This study was funded in January 2020 by the National Institute on Minority Health and Health Disparities of the National Institutes of Health. Formative activities will take place from April 2020-July 2021; the CDS tools will be developed May 2021-November 2022; the pilot study will be conducted August 2021-July 2022; and the main trial will occur December 2022-May 2024. Study data will be analyzed, and results disseminated, in 2024. CONCLUSIONS Patients’ social risk information must be presented to care teams in a way that facilitates social risk-informed care. To our knowledge, this study is the first to develop and test EHR-embedded CDS tools designed to support the provision of social risk-informed care. Study results will add needed understanding of how to use social risk data to improve health outcomes and reduce disparities.

scholarly journals Challenges involved in establishing a web-based clinical decision support tool in community health centers

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 100488
Author(s):  
Rachel Gold ◽  
Mary Middendorf ◽  
John Heintzman ◽  
Joan Nelson ◽  
Patrick O'Connor ◽  
...  
Keyword(s):  
Decision Support ◽  
Community Health ◽  
Clinical Decision Support ◽  
Community Health Centers ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Health Centers ◽  
Web Based ◽  
Support Tool ◽  
Clinical Decision Support Tool

Organizational Factors Influencing the Use of Clinical Decision Support for Improving Cancer Screening Within Community Health Centers

2016 ◽  
pp. 118-148 ◽  
Author(s):  
Timothy Jay Carney ◽  
Michael Weaver ◽  
Anna M. McDaniel ◽  
Josette Jones ◽  
David A. Haggstrom
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Decision Support ◽  
Cancer Screening ◽  
Community Health ◽  
Clinical Decision Support ◽  
Community Health Centers ◽  
Clinical Decision ◽  
Health Centers ◽  
Practice Setting

Adoption of clinical decision support (CDS) systems leads to improved clinical performance through improved clinician decision making, adherence to evidence-based guidelines, medical error reduction, and more efficient information transfer and to reduction in health care disparities in under-resourced settings. However, little information on CDS use in the community health care (CHC) setting exists. This study examines if organizational, provider, or patient level factors can successfully predict the level of CDS use in the CHC setting with regard to breast, cervical, and colorectal cancer screening. This study relied upon 37 summary measures obtained from the 2005 Cancer Health Disparities Collaborative (HDCC) national survey of 44 randomly selected community health centers. A multi-level framework was designed that employed an all-subsets linear regression to discover relationships between organizational/practice setting, provider, and patient characteristics and the outcome variable, a composite measure of community health center CDS intensity-of-use. Several organizational and provider level factors from our conceptual model were identified to be positively associated with CDS level of use in community health centers. The level of CDS use (e.g., computerized reminders, provider prompts at point-of-care) in support of breast, cervical, and colorectal cancer screening rate improvement in vulnerable populations is determined by both organizational/practice setting and provider factors. Such insights can better facilitate the increased uptake of CDS in CHCs that allows for improved patient tracking, disease management, and early detection in cancer prevention and control within vulnerable populations.

scholarly journals A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines

2021 ◽  
Author(s):  
Tessa Jaspers ◽  
Marjolijn Duisenberg-van Essenberg ◽  
Barbara Maat ◽  
Marc Durian ◽  
Roy van den Berg ◽  
...  
Keyword(s):  
Decision Support ◽  
Venous Thromboembolism ◽  
Clinical Decision Support ◽  
Guideline Adherence ◽  
Intervention Group ◽  
Clinical Decision ◽  
Multifaceted Intervention ◽  
Annual Number ◽  
Post Intervention ◽  
Mobile Phone Application

AbstractBackground Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low. Objective To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented. Setting A Dutch general teaching hospital. Method A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients. Main outcome measure Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements. Results 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4 to 82.4% (OR 4.78; 95%CI 2.37–9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5 to 84.3% (OR 2.46; 95%CI 1.31–4.62), resulting in the potential prevention of ± 261 venous thromboembolisms per year. Conclusions Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence.

scholarly journals Clinical Decision Support and Palivizumab

2015 ◽  
Vol 06 (04) ◽  
pp. 769-784 ◽  
Author(s):  
A. Hogan ◽  
J. Michel ◽  
A.R. Localio ◽  
D. Karavite ◽  
L. Song ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Intervention Group ◽  
Clinical Decision ◽  
Partial Recovery ◽  
Patient Identification ◽  
Percentage Points ◽  
Comprehensive Intervention ◽  
Syncytial Virus ◽  
To Receive

SummaryBackground and Objectives: Palivizumab can reduce hospitalizations due to respiratory syncytial virus (RSV), but many eligible infants fail to receive the full 5-dose series. The efficacy of clinical decision support (CDS) in fostering palivizumab receipt has not been studied. We sought a comprehensive solution for identifying eligible patients and addressing barriers to palivizumab administration.Methods: We developed workflow and CDS tools targeting patient identification and palivizumab administration. We randomized 10 practices to receive palivizumab-focused CDS and 10 to receive comprehensive CDS for premature infants in a 3-year longitudinal cluster-randomized trial with 2 baseline and 1 intervention RSV seasons.Results: There were 356 children eligible to receive palivizumab, with 194 in the palivizumab-focused group and 162 in the comprehensive CDS group. The proportion of doses administered to children in the palivizumab-focused intervention group increased from 68.4% and 65.5% in the two baseline seasons to 84.7% in the intervention season. In the comprehensive intervention group, proportions of doses administered declined during the baseline seasons (from 71.9% to 62.4%) with partial recovery to 67.9% during the intervention season. The palivizumab-focused group improved by 19.2 percentage points in the intervention season compared to the prior baseline season (p < 0.001), while the comprehensive intervention group only improved 5.5 percentage points (p = 0.288). The difference in change between study groups was significant (p = 0.05).Conclusions: Workflow and CDS tools integrated in an EHR may increase the administration of palivizumab. The support focused on palivizumab, rather than comprehensive intervention, was more effective at improving palivizumab administration.

scholarly journals A Multifaceted Clinical Decision Support Intervention to Improve Adherence to Thromboprophylaxis Guidelines 

2021 ◽  
Author(s):  
Tessa Jaspers ◽  
Marjolijn Duisenberg-van Essenberg ◽  
Barbara Maat ◽  
Marc Durian ◽  
Roy van den Berg ◽  
...  
Keyword(s):  
Decision Support ◽  
Venous Thromboembolism ◽  
Clinical Decision Support ◽  
Guideline Adherence ◽  
Intervention Group ◽  
Clinical Decision ◽  
Multifaceted Intervention ◽  
Annual Number ◽  
Post Intervention ◽  
Mobile Phone Application

Abstract Background: Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low.Objective: To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented.Setting: A Dutch general teaching hospital.Method: A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients.Main outcome measure: Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements.Results: 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4% to 82.4% (OR 4.78; 95%CI 2.37-9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5% to 84.3% (OR 2.46; 95%CI 1.31-4.62), resulting in the potential prevention of ±261 venous thromboembolisms per year.Conclusions: Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence.

scholarly journals Real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury

2012 ◽  
Vol 03 (02) ◽  
pp. 221-238 ◽  
Author(s):  
Z.L. Cox ◽  
E.B. Neal ◽  
L.R. Waitman ◽  
N.B. Peterson ◽  
G. Bhave ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Adverse Drug Events ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Intervention Group ◽  
Kidney Injury ◽  
Clinical Decision ◽  
Care Hospital

Summary Objectives: Clinical decision support (CDS), such as computerized alerts, improves prescribing in the setting of acute kidney injury (AKI), but considerable opportunity remains to improve patient safety. The authors sought to determine whether pharmacy surveillance of AKI patients could detect and prevent medication errors that are not corrected by automated interventions. Methods: The authors conducted a randomized clinical trial among 396 patients admitted to an academic, tertiary care hospital between June 1, 2010 and August 31, 2010 with an acute 0.5 mg/dl change in serum creatinine over 48 hours and a nephrotoxic or renally cleared medication order. Patients randomly assigned to the intervention group received surveillance from a clinical pharmacist using a web-based surveillance tool to monitor drug prescribing and kidney function trends. CDS alerting and standard pharmacy services were active in both study arms. Outcome measures included blinded adjudication of potential adverse drug events (pADEs), adverse drug events (ADEs) and time to provider modification or discontinuation of targeted nephrotoxic or renally cleared medications. Results: Potential ADEs or ADEs occurred for 104 (8.0%) of control and 99 (7.1%) of intervention patient-medication pairs (p=0.4). Additionally, the time to provider modification or discontinuation of targeted nephrotoxic or renally cleared medications did not differ between control and intervention patients (33.4 hrs vs. 30.3hrs, p=0.3). Conclusions: Pharmacy surveillance had no incremental benefit over previously implemented CDS alerts

scholarly journals Effectiveness of an Advanced Clinical Decision Support System on Clinical Decision-Making Skills in a Call Center Medication Therapy Management Pharmacy Setting: A Pilot Study

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 228
Author(s):  
Jennifer M. Bingham ◽  
Veronique Michaud ◽  
Jacques Turgeon ◽  
David R. Axon
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Call Center ◽  
Intervention Group ◽  
Clinical Decision ◽  
Control Group ◽  
Clinical Recommendations ◽  
Medication Therapy ◽  
Post Test ◽  
Pharmacy Setting

(1) Background: There is limited evidence related to the efficacy of advanced clinical decision support systems (CDSS) on the quantity of high-quality clinical recommendations in a pharmacy-related medication therapy management (MTM) setting. The study aimed to assess the effect of an advanced CDSS on the quantity of relevant clinical pharmacist recommendations in a call center MTM setting. (2) Methods: This pre-test/post-test with comparator group study compared clinical skills assessment scores between certified MTM pharmacists in March 2020. A Wilcoxon Signed Rank test assessed the difference between pre- and post-test scores in both groups. (3) Results: Of 20 participants, the majority were less than 40 years old (85%) with a Doctor of Pharmacy degree (90%). Nine were female. Intervention group participants had less than three years of experience as a pharmacist. The control group had less than three years (40%) or seven to ten years (40%) of experience. There was a significant increase in intervention group scores between pre- (median = 3.0, IQR = 3.0) and post-test segments (median = 6.5, IQR = 4.0, p = 0.02). There was no significant change between control group pre- and post-test segments (p = 0.48). (4) Conclusion: Pharmacist exposure to an advanced CDSS was associated with significantly increased quantity of relevant clinical recommendations in an MTM pharmacy setting.

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