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Kersey E, Li J, Kay J, Adler-Milstein J, Yazdany J, Schmajuk G. Development and application of Breadth-Depth-Context (BDC), a conceptual framework for measuring technology engagement with a qualified clinical data registry. JAMIA Open 2024; 7:ooae061. [PMID: 39070967 PMCID: PMC11278873 DOI: 10.1093/jamiaopen/ooae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 07/30/2024] Open
Abstract
Objectives Despite the proliferation of dashboards that display performance data derived from Qualified Clinical Data Registries (QCDR), the degree to which clinicians and practices engage with such dashboards has not been well described. We aimed to develop a conceptual framework for assessing user engagement with dashboard technology and to demonstrate its application to a rheumatology QCDR. Materials and Methods We developed the BDC (Breadth-Depth-Context) framework, which included concepts of breadth (derived from dashboard sessions), depth (derived from dashboard actions), and context (derived from practice characteristics). We demonstrated its application via user log data from the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) registry to define engagement profiles and characterize practice-level factors associated with different profiles. Results We applied the BDC framework to 213 ambulatory practices from the RISE registry in 2020-2021, and classified practices into 4 engagement profiles: not engaged (8%), minimally engaged (39%), moderately engaged (34%), and most engaged (19%). Practices with more patients and with specific electronic health record vendors (eClinicalWorks and eMDs) had a higher likelihood of being in the most engaged group, even after adjusting for other factors. Discussion We developed the BDC framework to characterize user engagement with a registry dashboard and demonstrated its use in a specialty QCDR. The application of the BDC framework revealed a wide range of breadth and depth of use and that specific contextual factors were associated with nature of engagement. Conclusion Going forward, the BDC framework can be used to study engagement with similar dashboards.
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Affiliation(s)
- Emma Kersey
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Jing Li
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Julia Kay
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Julia Adler-Milstein
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158, United States
- Department of Medicine, Division of Clinical Informatics and Digital Transformation, University of California San Francisco, San Francisco, CA 94143, United States
| | - Jinoos Yazdany
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, CA 94143, United States
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158, United States
| | - Gabriela Schmajuk
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, CA 94143, United States
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158, United States
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, United States
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Mukherjee M, Okusi C, Jamie G, Byford R, Ferreira F, Fletcher M, de Lusignan S, Sheikh A. Deploying an asthma dashboard to support quality improvement across a nationally representative sentinel network of 7.6 million people in England. NPJ Prim Care Respir Med 2024; 34:18. [PMID: 38951547 PMCID: PMC11217285 DOI: 10.1038/s41533-024-00377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/21/2024] [Indexed: 07/03/2024] Open
Abstract
Every year, there are ~100,000 hospital admissions for asthma in the UK, many of which are potentially preventable. Evidence suggests that carefully conceptualised and implemented audit and feedback (A&F) cycles have the potential to improve clinical outcomes for those with chronic conditions. We wanted to investigate the technical feasibility of developing a near-real time asthma dashboard to support A&F interventions for asthma management in primary care. We extracted cross-sectional data on asthma from 756 participating GP practices in the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) database in England comprising 7.6 million registered people. Summary indicators for a GP practice were compared to all participating RCGP RSC practices using practice-level data, for the week 6-12th-Mar-2023. A weekly, automated asthma dashboard with features that can support electronic-A&F cycles that compared key asthma indicators for a GP practice to RCGP RSC could be created ( https://tinyurl.com/3ydtrt85 ): 12-weeks-incidence 0.4% vs 0.4%, annual prevalence 6.1% vs 6.7%, inhaled relievers to preventer 1.2 vs 1.1, self-management plan given 83.4% vs 60.8%, annual reviews 36.8% vs 57.3%, prednisolone prescriptions 2.0% vs 3.2%, influenza vaccination 56.6% vs 55.5%, pneumococcal vaccination ever (aged ≥65 years) 90.2% vs 84.1% and current smokers 14.9% vs 14.8%. Across the RCGP RSC, the rate of hospitalisations was 0.024%; comparative data had to be suppressed for the study practice because of small numbers. We have successfully created an automated near real-time asthma dashboard that can be used to support A&F initiatives to improve asthma care and outcomes in primary care.
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Grants
- This work is carried out with the support of BREATHE - The Health Data Research Hub for Respiratory Health [MC_PC_19004] in partnership with Oxford-RCGP Clinical Informatics Digital Hub (ORCHID), a trusted research environment. BREATHE is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Health Data Research UK is funded by UK Research and Innovation, the Medical Research Council, the British Heart Foundation, Cancer Research UK, the National Institute for Health and Care Research, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), Chief Scientist Office of the Scottish Government Health and Social Care Directorates. This work was also funded by The Health Data Research UK, reference EDIN1 and Asthma + Lung UK, reference AUK-AC-2018-01.
- No Relevant Funding
- Health Data Research UK, grant number EDIN1
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Affiliation(s)
- Mome Mukherjee
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK.
- HDR UK BREATHE Respiratory Data Hub, Usher Institute, The University of Edinburgh, Edinburgh, UK.
- HDR UK Better Care, Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Cecilia Okusi
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gavin Jamie
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Byford
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Filipa Ferreira
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Monica Fletcher
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
- HDR UK BREATHE Respiratory Data Hub, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Simon de Lusignan
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
- HDR UK BREATHE Respiratory Data Hub, Usher Institute, The University of Edinburgh, Edinburgh, UK
- HDR UK Better Care, Usher Institute, The University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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3
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Wilson AS, Triller DM, Allen A, Burnett A, Gouveia-Pisano JA, Brenner A, Pritchard B, Medico C, Vazquez SR, Witt DM, Barnes GD. Digital dashboards for oral anticoagulation management: a literature scoping review. J Thromb Thrombolysis 2023; 56:568-577. [PMID: 37596426 PMCID: PMC10550856 DOI: 10.1007/s11239-023-02880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/20/2023]
Abstract
This scoping review summarizes the extent and characteristics of the published literature describing digital population management dashboards implemented to improve the quality of anticoagulant management. A standardized search protocol was executed to identify relevant manuscripts published between January 1, 2015 and May 31, 2022. The resulting records were systematically evaluated by multiple blinded reviewers and the findings from selected papers were evaluated and summarized. Twelve manuscripts were identified, originating from 5 organizations within the US and 2 from other countries. The majority (75%) described implementation in the outpatient setting. The identified papers described a variety of positive results of dashboard use, including a 24.5% reduction of questionable direct oral anticoagulant dosing in one organization, a 33.3% relative improvement in no-show appointments in an ambulatory care clinic, and a 75% improvement in intervention efficiency. One medical center achieved a 98.4% risk-appropriate venous thromboembolism risk prophylaxis prescribing rate and 40.6% reduction in anticoagulation-related adverse event rates. The manuscripts primarily described retrospective findings from single-center dashboard implementation experiences. Digital dashboards have been successfully implemented to support the anticoagulation of acute and ambulatory patients and available manuscripts suggest a positive impact on care-related processes and relevant patient outcomes. Prospective studies are needed to better characterize the implementation and impact of dashboards for anticoagulation management. Published reports suggest that digital dashboards may improve the quality, safety, and efficiency of anticoagulation management. Additional research is needed to validate these findings and to understand how best to implement these tools.
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Affiliation(s)
- Aaron S Wilson
- University of Utah College of Pharmacy, Salt Lake City, UT, 84112, USA
| | - Darren M Triller
- Anticoagulation Forum, 17 Lincoln St, Suite 2B, Newton, MA, 02461, USA.
| | - Arthur Allen
- VA Salt Lake City Health Care System, Salt Lake City, UT, 84108, USA
| | - Allison Burnett
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87102, USA
| | | | | | | | | | - Sara R Vazquez
- University of Utah College of Pharmacy, Salt Lake City, UT, 84112, USA
| | - Dan M Witt
- University of Utah College of Pharmacy, Salt Lake City, UT, 84112, USA
| | - Geoffrey D Barnes
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, 48109, USA
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Joy M, Williams J, Emanuel S, Kar D, Fan X, Delanerolle G, Field BC, Heiss C, Pollock KG, Sandler B, Arora J, Sheppard JP, Feher M, Hobbs FR, de Lusignan S. Trends in direct oral anticoagulant (DOAC) prescribing in English primary care (2014-2019). Heart 2023; 109:195-201. [PMID: 36371664 DOI: 10.1136/heartjnl-2022-321377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/15/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In England, most prescribing of direct-acting oral anticoagulants for atrial fibrillation (AF) is in primary care. However, there remain gaps in our understanding of dosage and disparities in use. We aimed to describe trends in direct oral anticoagulant (DOAC) prescribing, including dose reduction in people with renal impairment and other criteria, and adherence. METHODS Using English primary care sentinel network data from 2014 to 2019, we assessed appropriate DOAC dose adjustment with creatinine clearance (CrCl). Our primary care sentinel cohort was a subset of 722 general practices, with 6.46 million currently registered patients at the time of this study. RESULTS Of 6 464 129 people in the cohort, 2.3% were aged ≥18 years with a diagnosis of AF, and 30.8% of these were prescribed vitamin K antagonist and 69.1% DOACs. Appropriate DOAC prescribing following CrCl measures improved between 2014 and 2019; dabigatran from 21.3% (95% CI 15.1% to 28.8%) to 48.7% (95% CI 45.0% to 52.4%); rivaroxaban from 22.1% (95% CI 16.7% to 28.4%) to 49.9% (95% CI 48.5% to 53.3%); edoxaban from 10.0% (95% CI 0.3% to 44.5%) in 2016 to 57.6% (95% CI 54.5% to 60.7%) in 2019; apixaban from 30.8% (95% CI 9.1% to 61.4%) in 2015 to 60.5% (95% CI 57.8% to 63.2%) in 2019.Adherence was highest for factor Xa inhibitors, increasing from 50.1% (95% CI 47.7% to 52.4%) in 2014 to 57.8% (95% CI 57.4% to 58.2%) in 2019. Asian and black/mixed ethnicity was associated with non-adherence (OR 1.81, 95% CI 1.56 to 2.09) as was male gender (OR 1.19, 95% CI 1.15 to 1.22), higher socioeconomic status (OR 1.60, 95% CI 1.52 to 1.68), being an ex-smoker (OR 1.12, 95% CI 1.06 to 1.19) and hypertension (OR 1.07, 95% CI 1.03 to 1.17). CONCLUSIONS The volume and quality of DOAC prescribing has increased yearly. Future interventions to augment quality of anticoagulant management should target disparities in adherence.
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Affiliation(s)
- Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Subo Emanuel
- Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Benjamin Ct Field
- Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
- Diabetes & Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Christian Heiss
- Diabetes & Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Kevin G Pollock
- Innovative Medicines, Bristol-Myers Squibb Pharmaceuticals Ltd, London, UK
| | - Belinda Sandler
- Innovative Medicines, Bristol-Myers Squibb Pharmaceuticals Ltd, London, UK
| | - Jasleen Arora
- Innovative Medicines, Bristol-Myers Squibb Pharmaceuticals Ltd, London, UK
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Michael Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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5
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de Bekker PJGM, de Weerdt V, Vink MDH, van der Kolk AB, Donker MH, van der Hijden EJE. 'Give me something meaningful': GPs perspectives on how to improve an audit and feedback report provided by health insurers - an exploratory qualitative study. BMJ Open Qual 2022; 11:bmjoq-2022-002006. [PMID: 36375859 PMCID: PMC9664288 DOI: 10.1136/bmjoq-2022-002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Audit and feedback (A&F) is a valuable quality improvement strategy, which can contribute to de-implementation of low-value care. In the Netherlands, all health insurers collaboratively provide A&F to general practitioners (GPs), the 'Primary Care Practice Report' (PCPR). Unfortunately, the use of this report by GPs is limited. This study examined the thoughts of GPs on the usability of the PCPR and GPs recommendations for improving the PCPR. METHOD We used an interpretative qualitative design, with think-aloud tasks to uncover thoughts of GPs on the usability of the PCPR and semistructured interview questions to ask GPs' recommendations for improvement of the PCPR. Interviews were audiorecorded and transcribed ad verbatim. Data were analysed using thematic content analysis. RESULTS We identified two main themes: 'poor usability of the PCPR', and 'minimal motivation to change based on the PCPR'. The GPs found the usability of the PCPR poor due to the feedback not being clinically meaningful, the data not being recent, individual and reliable, the performance comparators offer insufficient guidance to assess clinical performance, the results are not discussed with peers and the definitions and visuals are unclear. The GPs recommended improving these issues. The GPs motivation to change based on the PCPR was minimal. CONCLUSIONS The GPs evaluated the PCPR as poorly usable and were minimally motivated to change. The PCPR seems developed from the perspective of the reports' commissioners, health insurers, and does not meet known criteria for effective A&F design and user-centred design. Importantly, the GPs did state that well-designed feedback could contribute to their motivation to improve clinical performance.Furthermore, the GPs stated that they receive a multitude of A&F reports, which they hardly use. Thus, we see a need for policy makers to invest in less, but more usable A&F reports.
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Affiliation(s)
- P J G M de Bekker
- Department of Health Economics & Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands .,Zorgvuldig Advies, Utrecht, Netherlands
| | - V de Weerdt
- Department of Health Economics & Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam University Medical Centres, Holendrecht, Netherlands
| | - M D H Vink
- Department of Health Economics & Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Gynaecology, Amsterdam Universitair Medische Centra, Duivendrecht, Netherlands
| | - A B van der Kolk
- Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M H Donker
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - E J E van der Hijden
- Department of Health Economics & Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Zilveren Kruis Health Insurance, Zeist, Netherlands
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6
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Hensley NB, Grant MC, Cho BC, Suffredini G, Abernathy JA. How Do We Use Dashboards to Enhance Quality in Cardiac Anesthesia? J Cardiothorac Vasc Anesth 2021; 35:2969-2976. [PMID: 34059439 DOI: 10.1053/j.jvca.2021.04.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/30/2021] [Accepted: 04/20/2021] [Indexed: 02/04/2023]
Abstract
The use of clinical dashboards has expanded significantly in healthcare in recent years in a variety of settings. The ability to analyze data related to quality metrics in one screen is highly desirable for cardiac anesthesiologists, as they have considerable influence on important clinical outcomes. Building a robust quality program within cardiac anesthesia relies on consistent access and review of quality outcome measures, process measures, and operational measures through a clinical dashboard. Signals and trends in these measures may be compared to other cardiac surgical programs to analyze gaps and areas for quality improvement efforts. In this article, the authors describe how they designed a clinical cardiac anesthesia dashboard for quality efforts at their institution.
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Affiliation(s)
- Nadia B Hensley
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian C Cho
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Giancarlo Suffredini
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - James A Abernathy
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
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