The relationship between office system tools and evidence-based care in primary care physician practice

Measuring Clinical Decision Support Influence on Evidence-Based Nursing Practice

PURPOSE/OBJECTIVES

To measure the effect of clinical decision support (CDS) on oncology nurse evidence-based practice (EBP).
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DESIGN

Longitudinal cluster-randomized design.
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SETTING

Four distinctly separate oncology clinics associated with an academic medical center.
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SAMPLE

The study sample was comprised of randomly selected data elements from the nursing documentation software. The data elements were patient-reported symptoms and the associated nurse interventions. The total sample observations were 600, derived from a baseline, posteducation, and postintervention sample of 200 each (100 in the intervention group and 100 in the control group for each sample).
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METHODS

The cluster design was used to support randomization of the study intervention at the clinic level rather than the individual participant level to reduce possible diffusion of the study intervention. An elongated data collection cycle (11 weeks) controlled for temporary increases in nurse EBP related to the education or CDS intervention.
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MAIN RESEARCH VARIABLES

The dependent variable was the nurse evidence-based documentation rate, calculated from the nurse-documented interventions. The independent variable was the CDS added to the nursing documentation software.
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FINDINGS

The average EBP rate at baseline for the control and intervention groups was 27%. After education, the average EBP rate increased to 37%, and then decreased to 26% in the postintervention sample. Mixed-model linear statistical analysis revealed no significant interaction of group by sample. The CDS intervention did not result in an increase in nurse EBP.
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CONCLUSIONS

EBP education increased nurse EBP documentation rates significantly but only temporarily. Nurses may have used evidence in practice but may not have documented their interventions.
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IMPLICATIONS FOR NURSING

More research is needed to understand the complex relationship between CDS, nursing practice, and nursing EBP intervention documentation. CDS may have a different effect on nurse EBP, physician EBP, and other medical professional EBP.

Understanding claims-based quality profiles in primary care practice: the role of office system tools and health information technology

BACKGROUND

Claims-based quality profiles are increasingly used by third-party payers as a means of monitoring and remunerating physician performance. As traditional approaches to assessing performance yield to electronically generated data, identifying practice tools capable of influencing the behavior of these measures becomes essential to effectively managing medical practices.

PURPOSE

The aim of this study was to examine the effect of using office system tools (i.e., patient registries, physician reminders, and flow sheets) and health information technology (HIT) on claims-based quality profile scores in primary care practices.

METHODOLOGY

We analyzed survey responses from primary care physicians (n = 191) regarding their use of office system tools and HIT. These responses were linked to quality profile scores obtained from a Blue Cross Blue Shield of Texas claims-based data set.

FINDINGS

Elevated quality profile scores were associated with physicians who reported higher use of HIT. In addition, the influence of one office system tool, physician reminders, was contingent upon the availability and use of HIT.

PRACTICE IMPLICATIONS

Our findings indicate that primary care practices that fail to implement or use HIT appropriately will fare poorly in systems that monitor and reward performance based on measures derived from claims data. Linking prompts or reminders directly to clinical actions that influence quality indicators endorsed by payers should be a component of quality assurance programs.