Partnered Decision Support: Parental Perspectives of Completing a Pre‐Visit Pediatric Asthma Questionnaire via the Patient Portal

Abstract Objective To determine utilization and impacts of a mobile electronic clinical decision support (mECDS) on pediatric asthma care quality in emergency department and inpatient settings. Methods We conducted an observational study of a mECDS tool that was deployed as part of a multi-dimensional, national quality improvement (QI) project focused on pediatric asthma. We quantified mECDS utilization using cumulative screen views over the study period in the city in which each participating site was located. We determined associations between mECDS utilization and pediatric asthma quality metrics using mixed-effect logistic regression models (adjusted for time, site characteristics, site-level QI project engagement, and patient characteristics). Results The tool was offered to clinicians at 75 sites and used on 286 devices; cumulative screen views were 4191. Children’s hospitals and sites with greater QI project engagement had higher cumulative mECDS utilization. Cumulative mECDS utilization was associated with significantly reduced odds of hospital admission (OR: 0.95, 95% CI: 0.92–0.98) and higher odds of caregiver referral to smoking cessation resources (OR: 1.08, 95% CI: 1.01–1.16). Discussion We linked mECDS utilization to clinical outcomes using a national sample and controlling for important confounders (secular trends, patient case mix, and concomitant QI efforts). We found mECDS utilization was associated with improvements in multiple measures of pediatric asthma care quality. Conclusion mECDS has the potential to overcome barriers to dissemination and improve care on a broad scale. Important areas of future work include improving mECDS uptake/utilization, linking clinicians’ mECDS usage to clinical practice, and studying mECDS’s impacts on other common pediatric conditions.

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Creation of a pharmacogenomics patient portal complementary to an existing institutional provider-facing clinical decision support system

JAMIA Open ◽

10.1093/jamiaopen/ooab067 ◽

2021 ◽

Vol 4 (3) ◽

Author(s):

Elizabeth Lipschultz ◽

Keith Danahey ◽

Tien M Truong ◽

Emily Schierer ◽

Samuel L Volchenboum ◽

...

Keyword(s):

Decision Support ◽

Decision Support System ◽

Clinical Decision Support ◽

Support System ◽

Clinical Decision Support System ◽

Data Access ◽

Clinical Decision ◽

Automated System ◽

Patient Portal ◽

Patient Resources

Abstract Background Applied pharmacogenomics presents opportunities for improving patient care through precision medicine, particularly when paired with appropriate clinical decision support (CDS). However, a lack of patient resources for understanding pharmacogenomic test results may hinder shared decision-making and patient confidence in treatment. We sought to create a patient pharmacogenomics education and results delivery platform complementary to a CDS system to facilitate further research on the relevance of patient education to pharmacogenomics. Methods We conceptualized a model that extended the data access layer of an existing institutional CDS tool to allow for the pairing of decision supports offered to providers with patient-oriented summaries at the same level of phenotypic specificity. We built a two-part system consisting of a secure portal for patient use and an administrative dashboard for patient summary creation. The system was built in an ASP.NET and AngularJS architecture, and all data was housed in a HIPAA-compliant data center, with PHI secure in transit and at rest. Results The YourPGx Patient Portal was deployed on the institutional network in June 2019. Fifty-eight unique patient portal summaries have been written so far, which can provide over 4500 results modules to the pilot population of 544 patients. Patient behavior on the portal is being logged for further research. Conclusions To our knowledge, this is the first automated system designed and deployed to provide detailed, personalized patient pharmacogenomics education complementary to a clinical decision support system. Future work will expand upon this system to allow for telemedicine and patient notification of new or updated results.

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Computer-based decision support for pediatric asthma management: description and feasibility of the Stop Asthma Clinical System

Health Informatics Journal ◽

10.1177/1460458206069761 ◽

2006 ◽

Vol 12 (4) ◽

pp. 259-273 ◽

Cited By ~ 22

Author(s):

Ross Shegog ◽

Leona K. Bartholomew ◽

Marianna M. Sockrider ◽

Danita I. Czyzewski ◽

Susan Pilney ◽

...

Keyword(s):

Decision Support ◽

Asthma Management ◽

Pediatric Asthma ◽

Computer Based

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Randomised trial to evaluate the effectiveness and impact of offering postvisit decision support and assistance in obtaining physician-recommended colorectal cancer screening: the e-assist: Colon Health study—a protocol study

BMJ Open ◽

10.1136/bmjopen-2018-023986 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023986 ◽

Cited By ~ 2

Author(s):

Jennifer Elston Lafata ◽

Yongyun Shin ◽

Susan A Flocke ◽

Sarah T Hawley ◽

Resa M Jones ◽

...

Keyword(s):

Colorectal Cancer ◽

Decision Support ◽

Usual Care ◽

Randomised Trial ◽

Health Study ◽

Care Group ◽

Average Risk ◽

Patient Portal ◽

Crc Screening ◽

Patient Reported

IntroductionHow to provide practice-integrated decision support to patients remains a challenge. We are testing the effectiveness of a practice-integrated programme targeting patients with a physician recommendation for colorectal cancer (CRC) screening.Methods and analysisIn partnership with healthcare teams, we developed ‘e-assist: Colon Health’, a patient-targeted, postvisit CRC screening decision support programme. The programme is housed within an electronic health record (EHR)-embedded patient portal. It leverages a physician screening recommendation as the cue to action and uses the portal to enrol and intervene with patients. Programme content complements patient–physician discussions by encouraging screening, addressing common questions and assisting with barrier removal. For evaluation, we are using a randomised trial in which patients are randomised to receive e-assist: Colon Health or one of two controls (usual care plus or usual care). Trial participants are average-risk, aged 50–75 years, due for CRC screening and received a physician order for stool testing or colonoscopy. Effectiveness will be evaluated by comparing screening use, as documented in the EHR, between trial enrollees in the e-assist: Colon Health and usual care plus (CRC screening information receipt) groups. Secondary outcomes include patient-perceived benefits of, barriers to and support for CRC screening and patient-reported CRC screening intent. The usual care group will be used to estimate screening use without intervention and programme impact at the population level. Differences in outcomes by study arm will be estimated with hierarchical logit models where patients are nested within physicians.Ethics and disseminationAll trial aspects have been approved by the Institutional Review Board of the health system in which the trial is being conducted. We will disseminate findings in diverse scientific venues and will target clinical and quality improvement audiences via other venues. The intervention could serve as a model for filling the gap between physician recommendations and patient action.Trial registration numberNCT02798224; Pre-results.

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The “Stop Asthma” Clinical System: A novel computer-based decision-support program to enhance implementation of pediatric asthma management guidelines and promote communication skills

Journal of Allergy and Clinical Immunology ◽

10.1016/s0091-6749(02)82095-4 ◽

2002 ◽

Vol 109 (1) ◽

pp. S312-S312

Author(s):

SL Abramson ◽

R Shegog ◽

LK Bartholomew ◽

MM Sockrider ◽

PD Mullen ◽

...

Keyword(s):

Decision Support ◽

Communication Skills ◽

Asthma Management ◽

Pediatric Asthma ◽

Support Program ◽

Management Guidelines ◽

System A ◽

Computer Based

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2505

Journal of Clinical and Translational Science ◽

10.1017/cts.2017.82 ◽

2017 ◽

Vol 1 (S1) ◽

pp. 19-20

Author(s):

Margaret Demment ◽

Ivelisse Rivera ◽

Morgan Pratte ◽

Miriam Weber ◽

Chris Morley ◽

...

Keyword(s):

Quality Of Life ◽

Decision Support ◽

Process Evaluation ◽

Medical Center ◽

Decision Support Tool ◽

Future Research ◽

Patient Portal ◽

Health Providers ◽

Support Tool

OBJECTIVES/SPECIFIC AIMS: The goal of this study is to assess how quality of life scores change in menopausal women before and after implementation of this aid. In addition, we are also interested in 2 process evaluation objectives: (1) determine if MyChart, the patient portal, is an effective way for this patient population to provide insight their quality of life to their providers and (2) to evaluate providers use of and reactions to the decision support tool. METHODS/STUDY POPULATION: This project is a collaboration between University of Rochester Medical Center and S.U.N.Y. Upstate Medical University. Participants were recruited through Upstate’s Family Medicine and OB/GYN practices via a MyChart invitation sent by the practices. Participating patients will be asked to complete a survey, through MyChart, every 3 months for 18 months. Participating health providers will be trained to use the decision support tool and participate in 3 interviews with the researchers to gain insight into the usefulness and effectiveness of the tool. RESULTS/ANTICIPATED RESULTS: Of the 465 eligible women, 117 women responded to our MyChart invitation to join our study. Of these, 105 agreed to participate and 98 met eligibility criteria. Only half of the women currently enrolled in our study had spoken to a provider about menopause related symptoms (56.1%) prior to study enrollment. DISCUSSION/SIGNIFICANCE OF IMPACT: The goal of this study is to improve menopause related symptoms in women, thus increasing their quality of life, but it will also provide important process evaluation for using EPIC and MyChart for future research studies.

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A Shared e-Decision Support Portal for Pediatric Asthma

Journal of Ambulatory Care Management ◽

10.1097/jac.0000000000000025 ◽

2014 ◽

Vol 37 (2) ◽

pp. 120-126 ◽

Cited By ~ 23

Author(s):

Alexander G. Fiks ◽

Stephanie Mayne ◽

Dean J. Karavite ◽

Elena DeBartolo ◽

Robert W. Grundmeier

Keyword(s):

Decision Support ◽

Pediatric Asthma

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Rapid Implementation of Remote Online Patient Portal Activation in a Children's Hospital during the COVID-19 Pandemic

ACI Open ◽

10.1055/s-0041-1729983 ◽

2021 ◽

Vol 05 (01) ◽

pp. e17-e26

Author(s):

Kim T. Vuong ◽

Tiranun Rungvivatjarus ◽

Isabel P. Garcia ◽

Cindy Lewis ◽

Lisa Miller ◽

...

Keyword(s):

Decision Support ◽

Hospital Discharge ◽

Clinical Decision Support ◽

Clinical Decision ◽

Medical Decision ◽

Inpatient Setting ◽

Activation Process ◽

Patient Portal ◽

Effect Change ◽

Inpatient Units

Abstract Background Patient portal access allows more patient engagement, yet portal usage is not universal. Telemedicine visits became critical when the coronavirus disease 2019 (COVID-19) pandemic limited in-office visits. Given physical distancing requirements and telemedicine platform integrated into the patient portal, our institution needed to rapidly enroll patients and their proxies remotely, including hospitalized patients, to minimize care disruptions. Objectives The study aimed to describe the rapid implementation of remote patient portal activation in a pediatric integrated delivery network during the COVID-19 pandemic. Additionally, to increase the percentage of patients with active portal status upon discharge by 15% (absolute change) across inpatient units within 3 months. Methods A multidisciplinary taskforce utilized quality improvement tools to identify barriers to successful inpatient patient portal activation followed by rapid intervention cycles to effect change. Weekly progress was monitored on a portal activation dashboard. Results We created clinical decision support tools and training within 2 weeks. Active patient portal status upon hospital discharge increased from 44 to 66% within 12 weeks. Online patient portal conversion within 7 days after hospital discharge increased from 6.0 to 24%. Offer rate increased from 73 to 85% across all inpatient units. Conclusion We rapidly and effectively implemented a remote proxy portal activation process in the inpatient setting. Remote activation, training, clinical decision support, multidisciplinary involvement, and emphasis on the portal as integral to ongoing care allowed us to dramatically increase portal conversion. This experience may be informative for pediatric hospitals aiming to increase proxy portal enrollment and adult hospitals with medical decision-making proxies.

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