scholarly journals Assessing the implementation of a clinical decision support tool in primary care for diabetes prevention: a qualitative interview study using the Consolidated Framework for Implementation Science

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Rebekah Pratt ◽  
Daniel M. Saman ◽  
Clayton Allen ◽  
Benjamin Crabtree ◽  
Kris Ohnsorg ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Care Team ◽  
Trial Registration ◽  
Web Based ◽  
Primary Care Clinics ◽  
Primary Care Settings ◽  
Qualitative Interview Study

Abstract Background In this paper we describe the use of the Consolidated Framework for Implementation Research (CFIR) to study implementation of a web-based, point-of-care, EHR-linked clinical decision support (CDS) tool designed to identify and provide care recommendations for adults with prediabetes (Pre-D CDS). Methods As part of a large NIH-funded clinic-randomized trial, we identified a convenience sample of interview participants from 22 primary care clinics in Minnesota, North Dakota, and Wisconsin that were randomly allocated to receive or not receive a web-based EHR-integrated prediabetes CDS intervention. Participants included 11 clinicians, 6 rooming staff, and 7 nurse or clinic managers recruited by study staff to participate in telephone interviews conducted by an expert in qualitative methods. Interviews were recorded and transcribed, and data analysis was conducted using a constructivist version of grounded theory. Results Implementing a prediabetes CDS tool into primary care clinics was useful and well received. The intervention was integrated with clinic workflows, supported primary care clinicians in clearly communicating prediabetes risk and management options with patients, and in identifying actionable care opportunities. The main barriers to CDS use were time and competing priorities. Finally, while the implementation process worked well, opportunities remain in engaging the care team more broadly in CDS use. Conclusions The use of CDS tools for engaging patients and providers in care improvement opportunities for prediabetes is a promising and potentially effective strategy in primary care settings. A workflow that incorporates the whole care team in the use of such tools may optimize the implementation of CDS tools like these in primary care settings. Trial registration Name of the registry: Clinicaltrial.gov. Trial registration number: NCT02759055. Date of registration: 05/03/2016. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT02759055 Prospectively registered.

scholarly journals Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

2020 ◽  
Vol 11 (04) ◽  
pp. 635-643
Author(s):  
Joan S. Ash ◽  
Dian Chase ◽  
Sherry Baron ◽  
Margaret S. Filios ◽  
Richard N. Shiffman ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
Technical Feasibility ◽  
Primary Care Settings ◽  
Worker Health ◽  
Operational Issues

Abstract Background Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.

scholarly journals Impact of Clinical Decision Support on Azithromycin Prescribing in Primary Care Clinics

2021 ◽  
Author(s):  
Alexandria May ◽  
Allison Hester ◽  
Kristi Quairoli ◽  
Jordan R. Wong ◽  
Sheetal Kandiah
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Primary Care Clinics

scholarly journals Availability and usage of clinical decision support systems (CDSSs) in office-based primary care settings in the USA

2019 ◽  
Vol 26 (1) ◽  
pp. e100015
Author(s):  
Xia Jing ◽  
Lina Himawan ◽  
Timothy Law
Keyword(s):  
Primary Care ◽  
Drug Interaction ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Preventive Services ◽  
Clinical Decision ◽  
Primary Care Settings ◽  
The Usa ◽  
Usage Rates

BackgroundA clinical decision support system (CDSS) covers a broad spectrum of applications, for example, screening reminders, can reduce malpractice, improve preventive services and enable better management of chronic conditions. CDSSs have traditionally been used successfully in large hospitals. The availability (ie, whether the function is provided by the software) and usage (ie, actual use) of a CDSS in office-based primary care settings, however, are less well studied.ObjectiveTo establish a benchmark of CDSS availability and usage in office-based primary care settings, particularly given the large volume of visits in such settings.MethodsWe used the 2015 Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey to conduct secondary data analysis. We selected preventive services reminders and drug interaction alerts, along with several other variables as examples of a CDSS.ResultsCDSS usage rates ranged from 68.5% to 100% among solo or non-solo primary care practices owned by physicians or physician groups that have electronic medical records (EMRs)/electronic health records (EHRs) and 44.7% to 96.1%, regardless of EMR/EHR status. According to proportion tests, solo practices had significantly lower CDSS usage and availability rates on several measures if the practice is entirely EMR/EHR based and significantly lower (16.3%–28.9%) CDSS usage rates than did non-solo practices on each measure, regardless of EMR/EHR status.ConclusionIn the USA, a CDSS, especially under the categories of basic preventive reminders and drug interaction alerts, is used routinely between 68% and 100% in primary care if a practice is entirely EMR/EHR based. More work is needed, however, to determine the reasons for large usage gaps between solo and non-solo practices and to reduce such gaps.

scholarly journals Development and use of a clinical decision support tool for behavioral health screening in primary care clinics

2017 ◽  
Vol 08 (02) ◽  
pp. 412-429 ◽  
Author(s):  
Timothy Burdick ◽  
Rodger Kessler
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Behavioral Health ◽  
Clinical Decision Support ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Support Tool ◽  
Clinical Process ◽  
Primary Care Clinics ◽  
Clinical Decision Support Tool

SummaryObjective: Screening, brief intervention, and referral for treatment (SBIRT) for behavioral health (BH) is a key clinical process. SBIRT tools in electronic health records (EHR) are infrequent and rarely studied. Our goals were 1) to design and implement SBIRT using clinical decision support (CDS) in a commercial EHR; and 2) to conduct a pragmatic evaluation of the impact of the tools on clinical outcomes.Methods: A multidisciplinary team designed SBIRT workflows and CDS tools. We analyzed the outcomes using a retrospective descriptive convenience cohort with age-matched comparison group. Data extracted from the EHR were evaluated using descriptive statistics.Results: There were 2 outcomes studied: 1) development and use of new BH screening tools and workflows; and 2) the results of use of those tools by a convenience sample of 866 encounters. The EHR tools developed included a flowsheet for documenting screens for 3 domains (depression, alcohol use, and prescription misuse); and 5 alerts with clinical recommendations based on screening; and reminders for annual screening. Positive screen rate was 21% (≥1 domain) with 60% of those positive for depression. Screening was rarely positive in 2 domains (11%), and never positive in 3 domains. Positive and negative screens led to higher rates of documentation of brief intervention (BI) compared with a matched sample who did not receive screening, including changes in psychotropic medications, updated BH terms on the problem list, or referral for BH intervention. Clinical process outcomes changed even when screening was negative.Conclusions: Modified workflows for BH screening and CDS tools with clinical recommendations can be deployed in the EHR. Using SBIRT tools changed clinical process metrics even when screening was negative, perhaps due to conversations about BH not captured in the screening flowsheet. Although there are limitations to the study, results support ongoing investigation.Citation: Burdick TE, Kessler RS. Development and use of a clinical decision support tool for behavioral health screening in primary care clinics. Appl Clin Inform 2017; 8: 412–429 https://doi.org/10.4338/ACI-2016-04-RA-0068

Effectiveness of clinical decision support to enhance delivery of family planning services in primary care settings

Contraception ◽  
2020 ◽  
Vol 101 (3) ◽  
pp. 199-204
Author(s):  
Silpa Srinivasulu ◽  
Seema D. Shah ◽  
Clyde B. Schechter ◽  
Linda Prine ◽  
Susan E. Rubin
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Family Planning ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Family Planning Services ◽  
Primary Care Settings

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

scholarly journals Barriers and facilitators to the adoption of electronic clinical decision support systems: a qualitative interview study with UK general practitioners

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elizabeth Ford ◽  
Natalie Edelman ◽  
Laura Somers ◽  
Duncan Shrewsbury ◽  
Marcela Lopez Levy ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
General Practitioners ◽  
Clinical Decision Support ◽  
Support Systems ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Structured Interview ◽  
Qualitative Interview Study ◽  
High Level

Abstract Background Well-established electronic data capture in UK general practice means that algorithms, developed on patient data, can be used for automated clinical decision support systems (CDSSs). These can predict patient risk, help with prescribing safety, improve diagnosis and prompt clinicians to record extra data. However, there is persistent evidence of low uptake of CDSSs in the clinic. We interviewed UK General Practitioners (GPs) to understand what features of CDSSs, and the contexts of their use, facilitate or present barriers to their use. Methods We interviewed 11 practicing GPs in London and South England using a semi-structured interview schedule and discussed a hypothetical CDSS that could detect early signs of dementia. We applied thematic analysis to the anonymised interview transcripts. Results We identified three overarching themes: trust in individual CDSSs; usability of individual CDSSs; and usability of CDSSs in the broader practice context, to which nine subthemes contributed. Trust was affected by CDSS provenance, perceived threat to autonomy and clear management guidance. Usability was influenced by sensitivity to the patient context, CDSS flexibility, ease of control, and non-intrusiveness. CDSSs were more likely to be used by GPs if they did not contribute to alert proliferation and subsequent fatigue, or if GPs were provided with training in their use. Conclusions Building on these findings we make a number of recommendations for CDSS developers to consider when bringing a new CDSS into GP patient records systems. These include co-producing CDSS with GPs to improve fit within clinic workflow and wider practice systems, ensuring a high level of accuracy and a clear clinical pathway, and providing CDSS training for practice staff. These recommendations may reduce the proliferation of unhelpful alerts that can result in important decision-support being ignored.

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