575 research outputs found

    Can nudge-interventions address health service overuse and underuse? Protocol for a systematic review

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    IntroductionNudge-interventions aimed at health professionals are proposed to reduce the overuse and underuse of health services. However, little is known about their effectiveness at changing health professionals’ behaviours in relation to overuse or underuse of tests or treatments.ObjectiveThe aim of this study is to systematically identify and synthesise the studies that have assessed the effect of nudge-interventions aimed at health professionals on the overuse or underuse of health services.Methods and analysisWe will perform a systematic review. All study designs that include a control comparison will be included. Any qualified health professional, across any specialty or setting, will be included. Only nudge-interventions aimed at altering the behaviour of health professionals will be included. We will examine the effect of choice architecture nudges (default options, active choice, framing effects, order effects) and social nudges (accountable justification and pre-commitment or publicly declared pledge/contract). Studies with outcomes relevant to overuse or underuse of health services will be included. Relevant studies will be identified by a computer-aided search of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, CINAHL, Embase and PsycINFO databases. Two independent reviewers will screen studies for eligibility, extract data and perform the risk of bias assessment using the criteria recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group. We will report our results in a structured synthesis format, as recommended by the Cochrane EPOC group.Ethics and disseminationNo ethical approval is required for this study. Results will be presented at relevant scientific conferences and in peer-reviewed literature

    Performance Measures Using Electronic Health Records: Five Case Studies

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    Presents the experiences of five provider organizations in developing, testing, and implementing four types of electronic quality-of-care indicators based on EHR data. Discusses challenges, and compares results with those from traditional indicators

    Contextualized clinical decision support to detect and prevent adverse drug events

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    Transactions of 2019 International Conference on Health Information Technology Advancement Vol. 4 No. 1

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    The Fourth International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 31 - Nov. 1, 2019. Conference Co-Chairs Bernard T. Han and Muhammad Razi, Department of Business Information Systems, Haworth College of Business, Western Michigan University Kalamazoo, MI 49008 Transaction Editor Dr. Huei Lee, Professor, Department of Computer Information Systems, Eastern Michigan University Ypsilanti, MI 48197 Volume 4, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

    Improving the Coordination of Care for Periprocedural Antithrombotic Medication Management in Patients Undergoing Elective Surgery

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    Background: Arranging periprocedural antithrombotic medication (ATM) management is a frequently encountered complex clinical challenge. Often, there is limited time between the pre-admission clinic visit and the surgical date to coordinate ATM management and communicate the plan to the patient. This increases the risk of perioperative adverse events, case delays and cancellations, and is a patient safety concern. A quality improvement project was undertaken to address improving ATM periprocedural care coordination for patients taking ATM undergoing elective surgery. A review of the literature found clinical decision support system (CDSS) alerts to be an effective strategy. The aim of the project was to improve the quality and safety of ATM by optimizing the care coordination pathway for periprocedural ATM management. Methods: A multidisciplinary team was formed to collaborate on the project aims,intervention, and implementation plan. The intervention was a computer application for auto-identification and flagging of ATM to deploy a CDSS alert for referral to an online workflow organization tool (list manager) to coordinate ATM periprocedural management. Current state analysis was conducted. Results. Qualitative and quantitative evidence demonstrated variation across surgical services in coordinating periprocedural ATM management. This data supported project approval by senior leadership. Request for programming was submitted. Planning for piloting the intervention in two clinical areas where bleeding is of critical concern continues. Conclusion. The project was complex in both scope and design, affecting multiple stakeholders with competing concerns. In the first iteration, the request for programming the CDSS alert was denied. This required the project team to pivot to an alternative solution, an online workflow organization tool (list manager) and extended the project timeline. Recommendations: This quality improvement project demonstrates the need for further quality improvement initiatives and research on improving the coordination of periprocedural ATM management. It highlights the complexity of this care coordination process
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