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Choksi P, Gay BL, Haymart MR, Papaleontiou M. Physician-Reported Barriers to Osteoporosis Screening: A Nationwide Survey. Endocr Pract 2023; 29:606-611. [PMID: 37156374 PMCID: PMC10526724 DOI: 10.1016/j.eprac.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Despite increased awareness, osteoporosis screening rates remain low. The objective of this survey study was to identify physician-reported barriers to osteoporosis screening. METHODS We conducted a survey of 600 physician members of the Endocrine Society, American Academy of Family Practice, and American Geriatrics Society. The respondents were asked to rate barriers to osteoporosis screening in their patients. We performed multivariable logistic regression analyses to determine correlates with the most commonly reported barriers. RESULTS Of 566 response-eligible physicians, 359 completed the survey (response rate, 63%). The most commonly reported barriers to osteoporosis screening included patient nonadherence (63%), physician concern about cost (56%), clinic visit time constraints (51%), low on the priority list (45%), and patient concern about cost (43%). Patient nonadherence as a barrier was correlated with physicians in academic tertiary centers (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.06-5.13), whereas clinic visit time constraints were correlated with physicians in both community-based academic affiliates and academic tertiary care ([OR, 1.96; 95% CI, 1.10-3.50] and [OR, 2.48; 95% CI, 1.22-5.07], respectively). Geriatricians (OR, 0.40; 95% CI, 0.21-0.76) and physicians with >10 years in practice were less likely to report clinic visit time constraints as a barrier (11-20 years: OR, 0.41; 95% CI, 0.20-0.85; >20 years: OR, 0.32; 95% CI, 0.16-0.65). Physicians with more patient-facing time (3-5 compared with 0.5-2 d/wk) were more likely to place screening low on the priority list (OR, 2.66; 95% CI, 1.34-5.29). CONCLUSION Understanding barriers to osteoporosis screening is vital in developing strategies to improve osteoporosis care.
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Affiliation(s)
- Palak Choksi
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brittany L Gay
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Megan R Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute of Gerontology, University of Michigan, Ann Arbor, Michigan.
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2
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Benes G, David J, Synowicz M, Betech A, Dasa V, Krause PC, Jones D, Hall L, Leslie L, Chapple AG. Race and Age Impact Osteoporosis Screening Rates in Women Prior to Hip Fracture. Arch Osteoporos 2022; 17:34. [PMID: 35150320 DOI: 10.1007/s11657-022-01076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/08/2022] [Indexed: 02/03/2023]
Abstract
Bone mineral density screening and clinical risk factors are important to stratify individuals for increased risk of fracture. In a population with no history of fractures or baseline bone density measurement, black women were less likely to be screened than white counterparts prior to hip fracture. PURPOSE To evaluate overall BMD (bone mineral density) screening rates within two years of hip fracture and to identify any disparities for osteoporosis screening or treatment in a female cohort who were eligible for screening under insurance and national recommendations. METHODS Data were obtained from 1,109 female patients listed in the Research Action for Health Network (REACHnet) database, which consists of multiple health partner systems in Louisiana and Texas. Patients < 65 years old or with a history of hip fracture or osteoporosis diagnosis, screening or treatment more than 2 years before hip fracture were removed. RESULTS Only 223 (20.1%) females were screened within the two years prior to hip fracture. Additionally, only 23 (10%) of the screened patients received treatment, despite 187 (86.6%) patients being diagnosed with osteoporosis or osteopenia. Screening rates reached a maximum of 27.9% in the 75-80 age group, while the 90 + age group had the lowest screening rates of 12%. We found a quadratic relationship between age and screening rates, indicating that the screening rate increases in age until age 72 and then decreases starkly. After adjusting for potential confounders, we found that black patients had significantly decreased screening rates compared to white patients (adjusted OR = .454, 95% CI = .227-.908, p value = .026) which held in general and for patient ages 65-97. CONCLUSION Despite national recommendations, overall BMD screening rates among women prior to hip fracture are low. If individuals are not initially screened when eligible, they are less likely to ever be screened prior to fracture. Clinicians should address racial disparities by recommending more screening to otherwise healthy black patients above the age of 65. Lastly, treatment rates need to increase among those diagnosed with osteoporosis since all patients went on to hip fracture.
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Affiliation(s)
- Gregory Benes
- Louisiana State University Health Sciences Center School of Medicine, 1901 Perdido St, New Orleans, LA, 70112, USA.
| | - Justin David
- Louisiana State University Health Sciences Center School of Medicine, 1901 Perdido St, New Orleans, LA, 70112, USA
| | - Molly Synowicz
- University of Toledo General Surgery Residency Program, Toledo, OH, USA
| | - Alex Betech
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
| | - Vinod Dasa
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
| | - Peter C Krause
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
| | - Deryk Jones
- Ochsner Sports Medicine Institute, Jefferson, LA, USA
| | - Lauren Hall
- Baylor Scott & White Health Research Institute, Dallas, TX, USA
| | - Lauren Leslie
- Ochsner Sports Medicine Institute, Jefferson, LA, USA
| | - Andrew G Chapple
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA.,Biostatistics Program, School of Public Health, LSU Health Sciences Center, New Orleans, LA, USA
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3
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Shah S, Yeheskel A, Hossain A, Kerr J, Young K, Shakik S, Nichols J, Yu C. The Impact of Guideline Integration into Electronic Medical Records on Outcomes for Patients with Diabetes: A Systematic Review. Am J Med 2021; 134:952-962.e4. [PMID: 33775644 DOI: 10.1016/j.amjmed.2021.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/21/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
Optimal strategies for integration of clinical practice guidelines into electronic medical records and its impact on processes of care and clinical outcomes in diabetic patients are not well understood. A systematic review of CINAHL, MEDLINE, PubMed, and Cochrane Library databases in August 2016, November 2017, and June 2020 was conducted. Studies investigating integration of diabetes guidelines into ambulatory care electronic medical records reporting quantitative results were included. After screening 15,783 records, 21 articles were included. Lipid and blood pressure control consistently improved with guideline integration, but A1c control remained equivocal. Electronic guideline integration improved microvascular complication screening, vaccination, and documentation of cardiovascular risk factors, while medication prescription and blood pressure, lipid, and A1c documentation did not improve. Studies employing a combination of electronic record intervention strategies were associated with improvement in monitoring and attainment of guideline and screening targets. Thus, strategies employing combinations of interventions to incorporate guidelines into electronic records may improve processes of care and some clinical outcomes.
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Affiliation(s)
- Sapna Shah
- Department of Medicine; Faculty of Medicine, University of Toronto, Ont, Canada
| | - Ariel Yeheskel
- Department of Medicine; Faculty of Medicine, University of Toronto, Ont, Canada
| | - Abrar Hossain
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Jenessa Kerr
- Department of Pediatrics, University of Calgary, Alb, Canada
| | | | | | - Jennica Nichols
- Faculty of Graduate and Postdoctoral Studies, University of British Columbia, Vancouver, Canada
| | - Catherine Yu
- Department of Medicine; Faculty of Medicine, University of Toronto, Ont, Canada; Dalla Lana School of Public Health; University of Toronto, Ont, Canada.
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4
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Greenwald JL, Greer JA, Gace D, Sommer RK, Daubman BR, Rosenberg LB, LaSala C, Jacobsen J. Implementing Automated Triggers to Identify Hospitalized Patients with Possible Unmet Palliative Needs: Assessing the Impact of This Systems Approach on Clinicians. J Palliat Med 2020; 23:1500-1506. [PMID: 32589501 DOI: 10.1089/jpm.2020.0161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Understanding patients' goals and values is important to ensure goal-concordant care; however, such discussions can be challenging. Little is known about the impact of having these discussions on hospitalists. Objective: To assess the impact on hospitalists of a system that reminds them to have serious illness conversations with their patients identified with potential unmet palliative needs. Design: Two group cohort trial. Setting/Subjects: Single academic center. Internal medicine hospitalist physicians, nurse practitioners, and physician's assistants. Measurements: Before the trial, all participants received serious illness conversation training. During the trial, hospitalists on intervention units received verbal notification when their recently admitted patients were identified using a computer algorithm as having possible unmet palliative needs. Hospitalists on the control unit received no notifications. At baseline and three months, hospitalists completed questionnaires regarding communication skill acquisition, perception of the importance of these conversations, and sense of the meaning gained from having them. Results: Both groups had similar improvements in their self-reported communication skills and experienced a small decline in how important they felt the conversations were. Neither group perceived having the discussions as being affectively harmful to patients. The intervention hospitalists, over time, reported a slight reduction in the sense of meaning they achieved from the conversations. Conclusion: Routinely informing hospitalists when their patients were identified as being at increased risk for unmet palliative needs did not increase the sense of meaning these providers achieved. It is likely the pretrial training accounted for many of the positive outcomes in communication skills observed in both arms of the trial.
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Affiliation(s)
- Jeffrey L Greenwald
- Core Educator Faculty, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph A Greer
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Denisa Gace
- Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert K Sommer
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leah B Rosenberg
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cynthia LaSala
- Department of Nursing, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juliet Jacobsen
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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5
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Coma E, Medina M, Méndez L, Hermosilla E, Iglesias M, Olmos C, Calero S. Effectiveness of electronic point-of-care reminders versus monthly feedback to improve adherence to 10 clinical recommendations in primary care: a cluster randomized clinical trial. BMC Med Inform Decis Mak 2019; 19:245. [PMID: 31783854 PMCID: PMC6884876 DOI: 10.1186/s12911-019-0976-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have analyzed the effectiveness of electronic reminder interventions to improve different clinical conditions, and most have reported a small to moderate effect. Few studies, however, have analyzed reminder systems targeting multiple conditions, and fewer still have compared electronic point-of-care reminders systems with other forms of feedback designed to improve delivery of care. METHODS We performed an unblinded cluster randomized clinical trial to compare the effectiveness of an electronic point-of-care reminder system with that of a well-established system providing monthly feedback on adherence to clinical recommendations. The control group received monthly feedback only while the intervention group received monthly feedback in addition to on-screen point-of-care reminders for 10 clinical conditions. The study targeted all physicians and nurses at the 283 primary care centers managed by the Institut Català de la Salut (approximately 6600 professionals). RESULTS Following exclusions and randomization, 132 primary care centers (328,728 patients with reminders) were assigned to the intervention group while 137 centers (317,117 patients with reminders) were randomized to the control group. A 20.6% improvement (OR 1.29, 95% CI: 1.25-1.34) in reminder resolution rates was observed in the intervention group. Results varied according to the clinical condition. The most effective reminder was screening for diabetic retinopathy (OR 1.51, 95% CI:1.46-1.57) while the least effective reminders were measurement of glycated hemoglobin (OR: 1.10, 95% CI: 1.07-1.13) and smoking cessation encouragement (OR 1.12, 95% CI: 1.09-1.16). CONCLUSIONS Electronic point-of-care reminders were more effective than the existing monthly feedback system at resolving the 10 clinical situations. However, more studies are needed to investigate the variations of the effect observed. TRIAL REGISTRATION Current Controlled Trials ISRCTN42391639, 08/10/2012. Retrospectively registered.
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Affiliation(s)
- Ermengol Coma
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Manuel Medina
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Leonardo Méndez
- Sistema d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Eduardo Hermosilla
- Sistema de Informació pel Desenvolupament d'Investigació en Atenció Primària (SIDIAP), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Manuel Iglesias
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Spain
| | - Carmen Olmos
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Spain
| | - Sebastian Calero
- UGEAP Hospitalet Nord. DAP Delta. Institut Català de la Salut, Barcelona, Spain
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Van de Velde S, Kunnamo I, Roshanov P, Kortteisto T, Aertgeerts B, Vandvik PO, Flottorp S. The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support. Implement Sci 2018; 13:86. [PMID: 29941007 PMCID: PMC6019508 DOI: 10.1186/s13012-018-0772-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/30/2018] [Indexed: 02/08/2023] Open
Abstract
Background Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. Methods We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. Results We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. Conclusions The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed. Electronic supplementary material The online version of this article (10.1186/s13012-018-0772-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stijn Van de Velde
- Centre for Informed Health Choices, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - Ilkka Kunnamo
- Duodecim, Scientific Society of Finnish Physicians, Helsinki, Finland
| | - Pavel Roshanov
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Bert Aertgeerts
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Per Olav Vandvik
- MAGIC Non-Profit Research and Innovation Programme, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Signe Flottorp
- Centre for Informed Health Choices, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
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7
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Bauer NS, Carroll AE, Saha C, Downs SM. Experience with decision support system and comfort with topic predict clinicians' responses to alerts and reminders. J Am Med Inform Assoc 2016; 23:e125-30. [PMID: 26567326 PMCID: PMC4954632 DOI: 10.1093/jamia/ocv148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/24/2015] [Accepted: 09/02/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Clinicians at our institution typically respond to about half of the prompts they are given by the clinic's computer decision support system (CDSS). We sought to examine factors associated with clinician response to CDSS prompts as part of a larger, ongoing quality improvement effort to optimize CDSS use. METHODS We examined patient, prompt, and clinician characteristics associated with clinician response to decision support prompts from the Child Health Improvement through Computer Automation (CHICA) system. We asked pediatricians who were nonusers of CHICA to rate decision support topics as "easy" or "not easy" to discuss with patients and their guardians. We analyzed these ratings and data, from July 1, 2009 to January 29, 2013, utilizing a hierarchical regression model, to determine whether factors such as comfort with the prompt topic and the length of the user's experience with CHICA contribute to user response rates. RESULTS We examined 414 653 prompts from 22 260 patients. The length of time a clinician had been using CHICA was associated with an increase in their prompt response rate. Clinicians were more likely to respond to topics rated as "easy" to discuss. The position of the prompt on the page, clinician gender, and the patient's age, race/ethnicity, and preferred language were also predictive of prompt response rate. CONCLUSION This study highlights several factors associated with clinician prompt response rates that could be generalized to other health information technology applications, including the clinician's length of exposure to the CDSS, the prompt's position on the page, and the clinician's comfort with the prompt topic. Incorporating continuous quality improvement efforts when designing and implementing health information technology may ensure that its use is optimized.
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Affiliation(s)
- Nerissa S Bauer
- Indiana University School of Medicine, Department of Pediatrics, Section of Children's Health Services Research, Indianapolis, Indiana, USA Indiana University School of Medicine, Department of Pediatrics, Section of Pediatric and Adolescent Comparative Effectiveness Research, Indianapolis, Indiana, USA
| | - Aaron E Carroll
- Indiana University School of Medicine, Department of Pediatrics, Section of Pediatric and Adolescent Comparative Effectiveness Research, Indianapolis, Indiana, USA Regenstrief Institute for Healthcare, Indianapolis, Indiana, USA
| | - Chandan Saha
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, Indiana, USA
| | - Stephen M Downs
- Indiana University School of Medicine, Department of Pediatrics, Section of Children's Health Services Research, Indianapolis, Indiana, USA Indiana University School of Medicine, Department of Pediatrics, Section of Pediatric and Adolescent Comparative Effectiveness Research, Indianapolis, Indiana, USA
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8
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Thomas RE, Vaska M, Naugler C, Chowdhury TT. Interventions to Educate Family Physicians to Change Test Ordering: Systematic Review of Randomized Controlled Trials. Acad Pathol 2016; 3:2374289516633476. [PMID: 28725760 PMCID: PMC5497906 DOI: 10.1177/2374289516633476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/14/2016] [Accepted: 01/23/2016] [Indexed: 11/16/2022] Open
Abstract
The purpose is to systematically review randomised controlled trials (RCTs) to change family physicians’ laboratory test-ordering. We searched 15 electronic databases (no language/date limitations). We identified 29 RCTs (4,111 physicians, 175,563 patients). Six studies specifically focused on reducing unnecessary tests, 23 on increasing screening tests. Using Cochrane methodology 48.5% of studies were low risk-of-bias for randomisation, 7% concealment of randomisation, 17% blinding of participants/personnel, 21% blinding outcome assessors, 27.5% attrition, 93% selective reporting. Only six studies were low risk for both randomisation and attrition. Twelve studies performed a power computation, three an intention-to-treat analysis and 13 statistically controlled clustering. Unweighted averages were computed to compare intervention/control groups for tests assessed by >5 studies. The results were that fourteen studies assessed lipids (average 10% more tests than control), 14 diabetes (average 8% > control), 5 cervical smears, 2 INR, one each thyroid, fecal occult-blood, cotinine, throat-swabs, testing after prescribing, and urine-cultures. Six studies aimed to decrease test groups (average decrease 18%), and two to increase test groups. Intervention strategies: one study used education (no change): two feedback (one 5% increase, one 27% desired decrease); eight education + feedback (average increase in desired direction >control 4.9%), ten system change (average increase 14.9%), one system change + feedback (increases 5-44%), three education + system change (average increase 6%), three education + system change + feedback (average 7.7% increase), one delayed testing. The conclusions are that only six RCTs were assessed at low risk of bias from both randomisation and attrition. Nevertheless, despite methodological shortcomings studies that found large changes (e.g. >20%) probably obtained real change.
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Affiliation(s)
- Roger Edmund Thomas
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcus Vaska
- Knowledge Resource Service, Holy Cross Centre, Calgary, Alberta, Canada
| | - Christopher Naugler
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.,Departments of Pathology & Laboratory Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tanvir Turin Chowdhury
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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9
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Njie GJ, Proia KK, Thota AB, Finnie RKC, Hopkins DP, Banks SM, Callahan DB, Pronk NP, Rask KJ, Lackland DT, Kottke TE. Clinical Decision Support Systems and Prevention: A Community Guide Cardiovascular Disease Systematic Review. Am J Prev Med 2015; 49:784-795. [PMID: 26477805 PMCID: PMC5074080 DOI: 10.1016/j.amepre.2015.04.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 12/11/2022]
Abstract
CONTEXT Clinical decision support systems (CDSSs) can help clinicians assess cardiovascular disease (CVD) risk and manage CVD risk factors by providing tailored assessments and treatment recommendations based on individual patient data. The goal of this systematic review was to examine the effectiveness of CDSSs in improving screening for CVD risk factors, practices for CVD-related preventive care services such as clinical tests and prescribed treatments, and management of CVD risk factors. EVIDENCE ACQUISITION An existing systematic review (search period, January 1975-January 2011) of CDSSs for any condition was initially identified. Studies of CDSSs that focused on CVD prevention in that review were combined with studies identified through an updated search (January 2011-October 2012). Data analysis was conducted in 2013. EVIDENCE SYNTHESIS A total of 45 studies qualified for inclusion in the review. Improvements were seen for recommended screening and other preventive care services completed by clinicians, recommended clinical tests completed by clinicians, and recommended treatments prescribed by clinicians (median increases of 3.8, 4.0, and 2.0 percentage points, respectively). Results were inconsistent for changes in CVD risk factors such as systolic and diastolic blood pressure, total and low-density lipoprotein cholesterol, and hemoglobin A1C levels. CONCLUSIONS CDSSs are effective in improving clinician practices related to screening and other preventive care services, clinical tests, and treatments. However, more evidence is needed from implementation of CDSSs within the broad context of comprehensive service delivery aimed at reducing CVD risk and CVD-related morbidity and mortality.
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Affiliation(s)
- Gibril J Njie
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Krista K Proia
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Anilkrishna B Thota
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Ramona K C Finnie
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - David P Hopkins
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.
| | - Starr M Banks
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - David B Callahan
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | | | - Kimberly J Rask
- Georgia Medical Care Foundation, Emory University, Atlanta, Georgia
| | - Daniel T Lackland
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
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10
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Vawdrey DK, Walsh C, Stetson PD. An integrated billing application to streamline clinician workflow. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2014; 2014:1141-1149. [PMID: 25954425 PMCID: PMC4420016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Between 2008 and 2010, our academic medical center transitioned to electronic provider documentation using a commercial electronic health record system. For attending physicians, one of the most frustrating aspects of this experience was the system's failure to support their existing electronic billing workflow. Because of poor system integration, it was difficult to verify the supporting documentation for each bill and impractical to track whether billable notes had corresponding charges. We developed and deployed in 2011 an integrated billing application called "iCharge" that streamlines clinicians' documentation and billing workflow, and simultaneously populates the inpatient problem list using billing diagnosis codes. Each month, over 550 physicians use iCharge to submit approximately 23,000 professional service charges for over 4,200 patients. On average, about 2.5 new problems are added to each patient's problem list. This paper describes the challenges and benefits of workflow integration across disparate applications and presents an example of innovative software development within a commercial EHR framework.
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Affiliation(s)
- David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY ; New York-Presbyterian Hospital, New York, NY
| | - Colin Walsh
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Peter D Stetson
- Department of Biomedical Informatics, Columbia University, New York, NY ; Department of Medicine, Columbia University, New York, NY ; ColumbiaDoctors, New York, NY
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11
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Abstract
BACKGROUND Health information technology (HIT) systems have the potential to reduce delayed, missed or incorrect diagnoses. We describe and classify the current state of diagnostic HIT and identify future research directions. METHODS A multi-pronged literature search was conducted using PubMed, Web of Science, backwards and forwards reference searches and contributions from domain experts. We included HIT systems evaluated in clinical and experimental settings as well as previous reviews, and excluded radiology computer-aided diagnosis, monitor alerts and alarms, and studies focused on disease staging and prognosis. Articles were organised within a conceptual framework of the diagnostic process and areas requiring further investigation were identified. RESULTS HIT approaches, tools and algorithms were identified and organised into 10 categories related to those assisting: (1) information gathering; (2) information organisation and display; (3) differential diagnosis generation; (4) weighing of diagnoses; (5) generation of diagnostic plan; (6) access to diagnostic reference information; (7) facilitating follow-up; (8) screening for early detection in asymptomatic patients; (9) collaborative diagnosis; and (10) facilitating diagnostic feedback to clinicians. We found many studies characterising potential interventions, but relatively few evaluating the interventions in actual clinical settings and even fewer demonstrating clinical impact. CONCLUSIONS Diagnostic HIT research is still in its early stages with few demonstrations of measurable clinical impact. Future efforts need to focus on: (1) improving methods and criteria for measurement of the diagnostic process using electronic data; (2) better usability and interfaces in electronic health records; (3) more meaningful incorporation of evidence-based diagnostic protocols within clinical workflows; and (4) systematic feedback of diagnostic performance.
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Affiliation(s)
- Robert El-Kareh
- Division of Biomedical Informatics, UCSD, , San Diego, California, USA
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Abstract
Clinical decision support systems can improve efficiency and standardization in patient care by flagging patient records due for recommended health maintenance screening. Despite the staggering numbers of people affected by osteoporosis, rates of bone mineral density screening by dual-emission X-ray absorptiometry remain low.
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Affiliation(s)
- Kori Dewing
- Virginia Mason Medical Center in Seattle, Washington, USA
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Van Kooy M. Editorial: Advanced Data Analytics in Performance Improvement. Jt Comm J Qual Patient Saf 2012; 38:443. [DOI: 10.1016/s1553-7250(12)38058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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