A Quality Improvement Project to Evaluate Auditor Satisfaction with Different Data Collection Methods for Auditing Compliance with Catheter Associated Urinary Tract Infection (CAUTI) Prevention Standards

Executive Summary A Quality Improvement Project to Evaluate Auditor Satisfaction with Different Data Collection Methods for Auditing Compliance with (CAUTI) Prevention Standards Problem Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infection (HAI) in the United States, representing about 40% of all HAIs (Palmer, Lee, Dutta-Linn, Wroe & Hartmann, 2013). Approximately 25% of indwelling urinary catheters are unnecessary and may potentially lead to CAUTIs if not maintained, cleaned, and cared for appropriately (Nazarko, 2012). Literature suggests that preventing CAUTIs is possible by implementing evidence based prevention standards. The PICO research question for CAUTI prevention and prevention standard data collection is: In a sampling of clinical auditors (P) does implementation of an electronic audit tool to collect data on compliance with CAUTI prevention care standards in addition to education on the electronic audit tool (I) differ from paper form auditing for CAUTI prevention care standards (C) and does it impact auditor satisfaction and/or data collected using the new tool (O). Goal The goal of this project was to assess if there were differences in paper versus electronic audit collection methods by evaluating pre- and post-implementation auditor satisfaction. In addition, an assessment of the two collection methods was completed to evaluate consistency related to number of audits collected and notable changes in compliance, thereby providing insight into if electronic data capture (EDC) is a reliable and efficient method. Objectives Project objectives included determining auditor satisfaction with paper versus electronic data collection methods and evaluation of implications of reliability with data collection methods by maintaining consistency with data. Plan Following Institutional Review Board approval from Regis University, the project was implemented and data were collected retro- and prospectively. There was an organizational transition to EDC, a questionnaire was distributed eliciting feedback from auditors on their satisfaction level, and compliance with the prevention standards was assessed for consistency pre- and post-implementation of the EDC tool. Questionnaire data were coded and entered into a spreadsheet and statistical software was used to determine if there were significant changes in auditor satisfaction. Finally, an assessment of differences in processes used to collect CAUTI prevention standard data was completed. Outcomes and Results Nine clinical auditors and one data analyst were exposed to both paper and EDC tools and completed the questionnaire. While there was not a statistically significant increase in satisfaction, there was a clinically significant increase in auditor satisfaction. There was a statistically significant difference noted between pre- and post- implementation compliance data, but this does not prove a causal relationship due to other confounding factors. There was also a statistically significant decrease in average time it took for auditors to collect audit data

Clin Pharmacol Ther

Physician responses to genomic information are vital to the success of precision medicine initiatives. We prospectively studied a pharmacogenomics implementation program for the propensity of clinicians to select antiplatelet therapy based on CYP2C19 loss-of-function variants in stented patients. Among 2,676 patients, 514 (19.2%) were found to have a CYP2C19 variant affecting clopidogrel metabolism. For the majority (93.6%) of the cohort, cardiologists received active and direct notification of CYP2C19 status. Over 12 months, 57.6% of poor metabolizers and 33.2% of intermediate metabolizers received alternatives to clopidogrel. CYP2C19 variant status was the most influential factor impacting the prescribing decision (hazard ratio [HR] in poor metabolizers 8.1, 95% confidence interval [CI] [5.4, 12.2] and HR 5.0, 95% CI [4.0, 6.3] in intermediate metabolizers), followed by patient age and type of stent implanted. We conclude that cardiologists tailored antiplatelet therapy for a minority of patients with a CYP2C19 variant and considered both genomic and nongenomic risks in their clinical decision-making.U01 HL105198/HL/NHLBI NIH HHS/United StatesU01 HG007253/HG/NHGRI NIH HHS/United StatesUL1 TR000445/TR/NCATS NIH HHS/United StatesU01 HL122904/HL/NHLBI NIH HHS/United StatesU19 HL065962/HL/NHLBI NIH HHS/United StatesU47 CI000824/CI/NCPDCID CDC HHS/United StatesU01 HG008672/HG/NHGRI NIH HHS/United StatesU01 HG006378/HG/NHGRI NIH HHS/United States2017-07-01T00:00:00Z26693963PMC489923

Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S.</p> <p>Methods</p> <p>Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices.</p> <p>Results</p> <p>The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction.</p> <p>Conclusions</p> <p>These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.</p

Adolescent Health Services: Access and Outcomes

Adolescence is a unique developmental period during which most lifelong mental health illnesses develop. Interventions and programs targeting adolescent health care utilization and effectiveness often fail to include measures of implementation science including long term sustainability and contextual characteristics. The purpose of this dissertation was to evaluate two programs designed to increase health care utilization and engagement in adolescent populations. Guided by the Practical, Robust, Implementation and Sustainability Framework (PRISM), strengths and weaknesses across model delivery and context of School-based Health Centers (SBHC) were assessed through in-depth interviews with clinicians, managers, and school staff. SBHC outcomes and services were assessed in comparison to traditional pediatric clinics using propensity score matching. And lastly, a pediatric navigation service for referral connection support was assessed on referral connection and predictors of referral noncompletion. The findings presented in this dissertation have important implications for informative implementation and delivery of programming and interventions

Electronic Health Record Functionality Needed to Better Support Primary Care

Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This manuscript presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and Meaningful Use (MU) objectives to define EHR functionality. Current objectives remain disease- rather than whole-person focused, ignoring factors like personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time as well as patient partnering activities, support for team based care, population management tools that deliver care, and reduced documentation burden. While Stage 3 MU’s focus on outcomes is laudable, enhanced functionality is still needed including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies

Antitrust Scrutiny of the Health Professions: Developing a Framework for Assessing Private Restraints

This Article has suggested that courts adopt an intermediate level of scrutiny, between per se and Rule of Reason analysis. Under this analysis, a rebuttable presumption of illegality attaches to those practices which in other contexts are per se illegal. The weight of this presumption varies with the familiarity of the court with the restraint, its similarity to traditional per se conduct, and the strength of the procompetitive justification.This analytical approach is desirable for two reasons. First,courts are reluctant to apply commercial per se rules of illegality to professional restraints, and with good reason. Professional practices do differ from purely commercial transactions. At the same time, however, some professionals do engage in highly anticompetitive practices. Courts ought to have a test for assessing these practices that is less cumbersome than full-blown Rule of Reason analysis. Second, a truly competitive market for health services will provide better assurance of high quality care and reasonable prices than a market controlled by dominant professional groups. Competition will create incentives for providers and insurers to disseminate more information to consumers--information about prices, availability, billing procedures, and provider qualifications. Also,competition may encourage development of alternative forms of delivering services, particularly those that have the potential for increasing efficiency and reducing costs. By focusing on the procompetitive effects of professionally imposed restraints, courts will be able to review objectively both the economic and social consequences of the challenged activity. An intermediate level of review is not a radical departure from existing case law. Nevertheless, recognizing that it exists and spelling out how it should be conducted is important for the further development of the law in this area

Preparation and Use of Preconstructed Orders, Order Sets, and Order Menus in a Computerized Provider Order Entry System

Objective: To describe the configuration and use of the computerized provider order entry (CPOE) system used for inpatient and outpatient care at the authors' facility. Design: Description of order configuration entities, use patterns, and configuration changes in a production CPOE system. Measurements: The authors extracted and analyzed the content of order configuration entities (order dialogs, preconfigured [quick] orders, order sets, and order menus) and determined the number of orders entered in their production order entry system over the previous three years. The authors measured use of these order configuration entities over a six-month period. They repeated the extract two years later to measure changes in these entities. Results: CPOE system configuration, conducted before and after first production use, consisted of preparing 667 order dialogs, 5,982 preconfigured (quick) orders, and 513 order sets organized in 703 order menus for particular contexts, such as admission for a particular diagnosis. Fifty percent of the order dialogs, 57% of the quick orders, and 13% of the order sets were used within a six-month period. Over the subsequent two years, the volume of order configuration entities increased by 26%. Conclusions: These order configuration steps were time-consuming, but the authors believe they were important to increase the ordering speed and acceptability of the order entry software. Lessons learned in the process of configuring the CPOE ordering system are given. Better understanding of ordering patterns may make order configuration more efficient because many of the order configuration entities that were created were not used by clinician

The Patent Option

There is a shift in the shape of intellectual property (IP) tools used to strengthen and lengthen the right of pharmaceutical companies to exclude others from making and marketing their products. Patents have traditionally been the tool of choice. Over the past two decades, however, pharmaceutical companies have increased their degree of reliance on a right known as “data exclusivity.” This right, which now exists in most major jurisdictions, is the right to prevent third parties from relying on the clinical trial data submitted by another pharmaceutical company to obtain marketing approval for a bioequivalent or biosimilar product. The right is included in most international trade agreements. The patent and data exclusivity regimes are different. The patent regime is one-size-fits-all; it protects new, useful and nonobvious inventions subject to sufficiency of disclosure. In contrast, the data exclusivity regime has both a different target (only pharmaceuticals) and purpose (efficacy & safety). The two systems are administered independently. Yet they apply to the same products and the two rights belong to the same entities. This Article proposes to prioritize data protection over patents by offering an extension of data exclusivity periods in exchange for not applying for a patent, or letting the patent lapse. As the Article explains, this would create stronger incentives to perform clinical research on molecules that may have positive outcomes in clinical trials including naturally occurring substances and other subpatentable inventions. The Article conditions the proposed extension on fuller disclosure of clinical data, which would benefit both the public and scientists. Although public disclosure of an invention is a key function of patent law, it is often of poor quality due to excessive use of “patentese.” In the specific case of pharmaceuticals, it is further weakened by the fact that patents are normally applied for well before human clinical trials have been concluded. Under current rules, clinical trial data submitted to governments are often not made public. Finally, the Article proposes text to be used in future trade agreements—with specific modalities for developing and least-developed countries