Impacts of Information Quality on the Use and Effectiveness of Computerized Clinical Reminders

A computerized clinical reminder (CCR) system is a type of decision support system triggered by a set of Boolean rules and a knowledge base to remind healthcare providers of a recommended action. CCR system has received increasing attention as a tool to improve evidence-based practice and quality of care. This study laid out the methodology to improve CCR information quality by aligning information flow with clinicians\u27 mental model in decision making. The results concluded the modified CCR features were perceived useful and better. This information quality framework not only expedited decision making, but significantly impacted the way clinicians prioritized CCR by eighty percent

Design of a Prostate Cancer Patient Navigation Intervention for a Veterans Affairs Hospital

Patient navigation programs have been launched nationwide in an attempt to reduce racial/ethnic and socio-demographic disparities in cancer care, but few have evaluated outcomes in the prostate cancer setting. The National Cancer Institute-funded Chicago Patient Navigation Research Program (C-PNRP) aims to implement and evaluate the efficacy of a patient navigation intervention for predominantly low-income minority patients with an abnormal prostate cancer screening test at a Veterans Affairs (VA) hospital in Chicago

Affecting TDAP Vaccination Rates Among Women: a Multifaceted Intervention

Despite the availability of a preventive vaccine, the incidence of pertussis in the United States has continued to increase over the past two decades and it is now considered the most common preventable infectious illness. Highly contagious in nature, it is estimated that about 50 million people are infected each year, and approximately 300,000 deaths occur worldwide (Centers for Disease Control and Prevention [CDC], 2012). In 2013, Indiana reported 616 cases (Indiana State Department of Health [ISDH], 2014). In spite of CDC recommendations on strategies that can improve vaccine delivery, rates of immunization remain low nationwide (CDC, 2014). The purpose of this evidence-based practice project was to determine if implementation of a multifaceted intervention that consisted of provider reminder and education, and standardization of Tdap vaccine delivery would increase vaccination rates among women aged 18 years and older. The Iowa Model of Evidence-based Practice and Kurt Lewin’s change theory were utilized for guidance to facilitate the transition of best evidence into practice. Within a women’s health clinic in Northern Indiana, a retrospective chart review was conducted prior to project implementation followed by a ten-week period during which provider education, provider prompts attached to charts of eligible patients, and a standardized protocol for vaccine delivery was introduced. A five-fold increase in immunization receipt was noted with 1.5% (n = 5) immunized pre-intervention, compared to 11.7% (n = 31) immunized during intervention; results revealed a statistically significant association between the intervention and vaccine receipt (X2= 26.555, p \u3c .0001). Additionally, chi-square was used to analyze variables of interest including age, ethnicity, type of visit (obstetric, post-partum, well visit or acute visit), and type of insurance coverage, which were examined to determine whether they affected vaccination receipt. Findings revealed that none of the variables significantly influenced the rate of immunization among the women. Results of this EBP project lend support to the recommendation of use of this multifaceted approach as a strategy to increase rate of immunizations

Review of health information technology usability study methodologies

Usability factors are a major obstacle to health information technology (IT) adoption. The purpose of this paper is to review and categorize health IT usability study methods and to provide practical guidance on health IT usability evaluation. 2025 references were initially retrieved from the Medline database from 2003 to 2009 that evaluated health IT used by clinicians. Titles and abstracts were first reviewed for inclusion. Full-text articles were then examined to identify final eligibility studies. 629 studies were categorized into the five stages of an integrated usability specification and evaluation framework that was based on a usability model and the system development life cycle (SDLC)-associated stages of evaluation. Theoretical and methodological aspects of 319 studies were extracted in greater detail and studies that focused on system validation (SDLC stage 2) were not assessed further. The number of studies by stage was: stage 1, task-based or user–task interaction, n=42; stage 2, system–task interaction, n=310; stage 3, user–task–system interaction, n=69; stage 4, user–task–system–environment interaction, n=54; and stage 5, user–task–system–environment interaction in routine use, n=199. The studies applied a variety of quantitative and qualitative approaches. Methodological issues included lack of theoretical framework/model, lack of details regarding qualitative study approaches, single evaluation focus, environmental factors not evaluated in the early stages, and guideline adherence as the primary outcome for decision support system evaluations. Based on the findings, a three-level stratified view of health IT usability evaluation is proposed and methodological guidance is offered based upon the type of interaction that is of primary interest in the evaluation

Diabetes Guidelines Implementation Toolkit

Diabetes Guidelines Implementation Toolkit is a capstone project aimed to help the Grady North Fulton Health Center to implement the American Diabetes Association (ADA) “Standards in Medical Care in Diabetes, 2011” guidelines. This toolkit can also be used to implement the diabetes guidelines in any other primary or community healthcare facility to improve diabetes care. Diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes, their support network, and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, blood lipids, and by receiving other preventive care practices in a timely manner. Once the decision to put into practice the evidence-based diabetes guidelines has been made, this implementation toolkit will serve as a guide to help go through the process of implementation. The toolkit will suggest practical ways to implement the use of the guidelines using a stepwise approach, resources and template materials such as information handouts, flow sheets, referral forms, sample patient letters, etc. will be provided in the toolkit to facilitate the implementation. The final goal of the implementations is to improve the delivery of effective preventive health care services and promote diabetes preventive behaviors in order to prevent diabetes, its complications and disabilities, and the burden associated with the disease

Barriers and Facilitators to Adherence to Follow-up for Abnormal Cervical Cytology: A Review of the Evidence with Implications for Clinical Practice

Cervical cancer is one of the most preventable cancers because of its slow progression, cytologically identifiable precursors and effective treatments (Leyden et al., 2005). However, it remains the third most common gynecological cancer, leading to an unnecessary number of deaths annually (Brookfield, Cheung, Lucci, Fleming & Koniaris, 2009). The key to decreasing the incidence of cervical cancer deaths begins with screening Pap smears and adherence with recommended follow-up care for abnormal results. Transportation, childcare issues, financial constraints, and need for reminders are consistently recognized as barriers to follow-up care (Abercrombie, 2001). Transportation and financial incentives, reminders, patient educational materials, and case management are effective facilitators to follow-up (Engelstad et al., 2005). Despite an automated reminder call system and transportation incentives being available at Muskingum Valley Health Centers (MVHC), the number of patients who do not return for follow-up appointments remains high. The purpose of this evidence-based practice (EBP) project was to ascertain common barriers and facilitators that either prevent or help patients make return visits and interventions that could increase adherence for return visits. To that end, this EBP project includes a thorough review and synthesis of the literature and a survey of the patients seeking care in the gynecology service line at Muskingum Valley Health Centers to understand their perspective about barriers and facilitators to plan for future interventions at the center. An extensive literature review was conducted utilizing several different data bases in order to find the highest level of evidence. During this process, the search methods were validated by a Health Sciences Librarian who is has experience in EBP. After obtaining the literature, it was analyzed and compared to the information obtained from the questionnaires from MVHC. The evidence was then used to determine the barriers and facilitators to follow-up care for the patients at MVHC. Based on the evidence and findings, amendable changes were determined.No embarg

DOES INFORMATION TECHNOLOGY INCREASE OR DECREASE HOSPITALS’ RISK? AN EMPIRICAL EXAMINATION OF COMPUTERIZED PHYSICIAN ORDER ENTRY AND MALPRACTICE CLAIMS

Information technology (IT) has significant potential to improve the quality of patient care, to lower costs, and to improve efficiency. However, IT leaves an electronic paper trail that may demonstrate negligence and thereby create legal risk. Emerging research suggests that this fear of electronic discovery is delaying IT adoption, thereby perpetuating inefficiencies. Is this fear founded? If it is, then policy changes are needed to remove this obstacle to streamlining the healthcare system. If not, then healthcare providers should move ahead to realize IT benefits without being stymied by irrational fears. We examined the relationship between Computerized Physician Order Entry (CPOE) and malpractice claims against hospitals in Florida between 1999 and 2006. CPOE reduces the number, severity, and disposition time of claims, while having no effect on the amounts paid. This indicates that CPOE reduces hospital legal risk, suggesting that fears of increased legal risk due to IT are unfounded

Post Foley Removal Guideline Process and Outcome Evaluation

When patients are admitted to a hospital patient safety should be a priority in all aspects of the care they receive. Preventing patients from acquiring hospital infections (HAIs) is one example of patient safety. All hospital employees have the responsibility to ensure that standard workflow and processes are in place to ensure this safety. The purposes of this Practice Inquiry Project (PIP) were to examine and develop interventions to decrease the risk of catheter associated urinary tract infections (CAUTIs), incorporate an effective process and standard workflow to implement evidence practice practices (EBP), and to evaluate the effectiveness of implementing the Post Foley Removal Guideline (PFRG) to prevent reinsertion of the indwelling catheter for urinary retention, and thereby decreasing the risk of developing a CAUTI. The clinical and fiscal impact of CAUTIs are quite significant as well as are the challenges to ensure best practices are implemented enterprise-wide to reduce these risks. The first manuscript is a literature review of the impact of CAUTIs and prevention strategies to decrease the risk. The purpose of this literature review is to examine the most effective strategies/interventions to prevent hospital acquired CAUTIs. Studies have noted that a majority of these infections are preventable, with insertion and duration of use being the two principle preventable risk factors (Alexis’s 2014; APIC 2009; Umscheid, 2011; US-HHS, 2014). The second manuscript in this series details the development of an organization structure and workflow that would provide a vehicle to identify risk factors and implement best practices hospital-wide. Through evaluation by senior nursing leadership, the Quality Improvement Project (QIP) was developed to create an organization structure that would be effective in implementing enterprise-wide evidence based practice (EBP) and ensure standard of care was being given in all areas to make an effective impact on lowering CAUTI rates. The final manuscript is a pre and post-retrospective analysis of the impact the Post Foley Removal Guideline (PFRG) had on the CAUTI rates, device days, hospital length of stay, re-insertion rates and compliance. The study noted a significant decrease in CAUTIs, with only partial compliance to the PFRG and no significant difference in device days. This indicates multiple factors are present when implementing a new protocol. This PI was instrumental in helping me develop knowledge and skills to evaluate the extent of a patient safety issue, develop leadership skills to facilitate changes within a large hospital system, translate EBP to the clinical units, and evaluate outcomes

The Use of Routinely Collected Data in Clinical Trial Research

RCTs are the gold standard for assessing the effects of medical interventions, but they also pose many challenges, including the often-high costs in conducting them and a potential lack of generalizability of their findings. The recent increase in the availability of so called routinely collected data (RCD) sources has led to great interest in their application to support RCTs in an effort to increase the efficiency of conducting clinical trials. We define all RCTs augmented by RCD in any form as RCD-RCTs. A major subset of RCD-RCTs are performed at the point of care using electronic health records (EHRs) and are referred to as point-of-care research (POC-R). RCD-RCTs offer several advantages over traditional trials regarding patient recruitment and data collection, and beyond. Using highly standardized EHR and registry data allows to assess patient characteristics for trial eligibility and to examine treatment effects through routinely collected endpoints or by linkage to other data sources like mortality registries. Thus, RCD can be used to augment traditional RCTs by providing a sampling framework for patient recruitment and by directly measuring patient relevant outcomes. The result of these efforts is the generation of real-world evidence (RWE). Nevertheless, the utilization of RCD in clinical research brings novel methodological challenges, and issues related to data quality are frequently discussed, which need to be considered for RCD-RCTs. Some of the limitations surrounding RCD use in RCTs relate to data quality, data availability, ethical and informed consent challenges, and lack of endpoint adjudication which may all lead to uncertainties in the validity of their results. The purpose of this thesis is to help fill the aforementioned research gaps in RCD-RCTs, encompassing tasks such as assessing their current application in clinical research and evaluating the methodological and technical challenges in performing them. Furthermore, it aims to assess the reporting quality of published reports on RCD-RCTs

Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

<p>Abstract</p> <p>Background</p> <p>Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs) have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care.</p> <p>Methods</p> <p>We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others), and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs) of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with care provided without a CCDSS. A study was considered to have a positive effect (<it>i.e.</it>, CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.</p> <p>Results</p> <p>Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35) of studies, including 64% (9/14) of medication dosing assistants, 82% (9/11) of management assistants using alerts/reminders, 38% (3/8) of management assistants using guidelines/algorithms, and 67% (2/3) of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15%) reported improvements, all of which were medication dosing assistants.</p> <p>Conclusion</p> <p>The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.</p