Evidence-based guidelines and decision support services: a discussion and evaluation in triple assessment of suspected breast cancer

We conducted interviews with 85 randomly selected general practitioners (GPs) in Central Sydney to examine patterns of referral of women with breast cancer, satisfaction with local services, awareness of evidence-based guidelines and suggestions for local support.Previous experience was the most frequently cited factor influencing choice of specialist (n=80, 94%)followed by personal knowledge of the consultant's expertise (n=72, 85%). Only one third of respondents agreed women wanted to be more involved in choosing the specialist (n=28, 33%). Of 79 women recently diagnosed with breast cancer, the majority (96%) had been referred to a male surgeon (n=71, 96%).While only 35% of the GPs rated the care received by women with breast cancer in local facilities as 'excellent', significantly fewer rated communication between GPs and specialists as 'excellent' (35% v19%, p<0.01). Younger GPs were less likely to rate communication as 'excellent' compared with GPs aged 55 years or older (p=0.01). Only 18% of GPs considered their patients as having been 'very well informed' about their treatment choices. Younger GPs were more likely than older GPs to recall all available breast cancer guidelines (p=0.02). Significantly more GPs (68%) requested seminars with experts than any other types of educational support (p<0.001).To improve outcomes for women with breast cancer, mechanisms to support communication between GPs and specialists are recommended. Seminars for GPs with experts who emphasize evidence-based guidelines should be funded and evaluated, especially for impact in meeting the needs of older GPs.

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978. Assessing the Impact of a Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.094 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S40-S40

Author(s):

Katherine Richardson ◽

Sarah Fouquet ◽

Ellen Kerns ◽

Russell Mcculloh

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Mental Workload ◽

Clinical Decision ◽

Medical Decision ◽

Evidence Based ◽

System Usability Scale ◽

Nasa Tlx ◽

Evidence Based Guidelines ◽

The Impact

Abstract Background Fever in infants <90 days old can indicate a serious bacterial infection (SBI) such as urinary tract infection, bacteremia, or meningitis. Clinical management of febrile infants varies widely. Implementing clinical practice guidelines (CPGs) can help standardize care, and electronic clinical decision support (eCDS) tools are a potential means of distributing CPGs. Little is known regarding the individual-level impact of eCDS tool use on medical decision-making. Children’s Mercy Kansas City developed a mobile eCDS tool (CMPeDS: Pediatric Decision Support) that was used internationally in a practice standardization project focused on the management of febrile infants. Methods We conducted a prospective cross-over simulation study amongst pediatric healthcare providers. Attending and resident physicians performed simulated patient scenarios using either CMPeDS or a standard text reference (the Harriet Lane Handbook). Participants’ responses in the simulation were evaluated based on adherence to evidence-based guidelines. Participants’ mental workload was assessed using the NASA Task Load Index survey (NASA-TLX, in which lower scores are optimal) to assesses mental, physical, and temporal demand, as well as performance, effort, and frustration when completing a series of tasks. Paired t-test and ANOVA were used to determine significance for case performance scores and NASA-TLX scores, respectively. A System Usability Scale (SUS) was used to determine usability of the CMPeDS app. Results A total 28 of 32 planned participants have completed trial procedures to date. Mean performance scores on the cases were significantly higher with CMPeDS vs. standard reference, (87.7% vs. 72.4% [t(27) 3.22, P = 0.003]). Participants reported lower scores on the NASA-TLX when using CMPeDS compared with standard reference tool (Figure 1). Mean score on SUS was 88.2 (scale 0–100) indicating excellent tool usability (Figure 2). Conclusion Using the eCDS tool CMPeDS was associated with significantly increased adherence to evidence-based guidelines for febrile infant management and decreased mental workload in simulation. Our findings highlight the potential value of eCDS deployment as part of CPG implementation projects. Disclosures All authors: No reported disclosures.

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LO22: Implementation of an electronic clinical decision support tool to improve knowledge translation and imaging appropriateness for patients with mild traumatic brain injury and suspected pulmonary embolism

CJEM ◽

10.1017/cem.2017.84 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S34-S35

Author(s):

J. Andruchow ◽

D. Grigat ◽

A. McRae ◽

G. Innes ◽

E. Lang

Keyword(s):

Pulmonary Embolism ◽

Decision Support ◽

Point Of Care ◽

Decision Support Tool ◽

Clinical Decision ◽

Evidence Based ◽

Support Tool ◽

Imaging Appropriateness ◽

Ct Head ◽

Evidence Based Guidelines

Introduction/Innovation Concept: Utilization of CT imaging has increased dramatically over the past two decades, but has not necessarily improved patient outcomes. As healthcare spending grows unsustainably and evidence of harms from unnecessary testing accrues, there is pressure to improve imaging appropriateness. However, prior attempts to reduce unnecessary imaging using evidence-based guidelines have met with limited success, with common barriers cited including a lack of confidence in patient outcomes, medicolegal risk, and patient expectations. This project attempts to address these barriers through the development of an electronic clinical decision support (CDS) tool embedded in clinical practice. Methods: An interactive web-based point-of-care CDS tool was incorporated into computerized physician order entry software to provide real-time evidence-based guidance to emergency physicians for select clinical indications. For patients with mild traumatic brain injury (MTBI), decision support for the Canadian CT Head Rule pops up when a CT head is ordered. For patients with suspected pulmonary embolism (PE), the tool is triggered when a CT pulmonary angiogram is ordered and provides CDS for the Pulmonary Embolism Rule-out Criteria (PERC), Wells Score, age-adjusted D-dimer and CT imaging. To study the impact of the tool, all emergency physicians in the Calgary zone were randomized to receive voluntary decision support for either MTBI or PE. Curriculum, Tool, or Material: The tool uses a multifaceted approach to inform physician decision making, including visualization of risk and quantitative outcomes data and links to primary literature. The CDS tool simultaneously documents guideline compliance in the health record, generates printable patient education materials, and populates a REDCap™ database, enabling the creation of confidential physician report cards on CT utilization, appropriateness and diagnostic yield for both audit and feedback and research purposes. Preliminary data show that physicians are using the MTBI CDS approximately 30% of the time, and the PE CDS approximately 40% of the time. Evaluation of CDS impact on imaging utilization and appropriateness is ongoing. Conclusion: A voluntary web-based point-of-care decision support tool embedded in workflow has the potential to address many of the factors typically cited as barriers to use of evidence-based guidelines in practice. However, high rates of adherence to CDS will likely require physician incentives and appropriateness measures.

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2261

Journal of Clinical and Translational Science ◽

10.1017/cts.2017.256 ◽

2017 ◽

Vol 1 (S1) ◽

pp. 72-72

Author(s):

Albert Liao ◽

Grant W. Carlson ◽

John William Eley ◽

Theresa W. Gillespie

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Breast Conserving Surgery ◽

The United States ◽

Early Stage Breast Cancer ◽

National Database ◽

Evidence Based ◽

Median Income ◽

Study Results ◽

Evidence Based Guidelines

OBJECTIVES/SPECIFIC AIMS: Evidence-based guideline-concordant care leads to better outcomes in patients with early stage breast cancer, including survival. However, previous studies of guideline compliance have been limited by small study sample sizes, localized geography, unknown causal factors, and lack of diverse population. We use a national database to assess socio-economic, clinical, and facility factors that impact treatment compliance with evidence-based guidelines from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). METHODS/STUDY POPULATION: This is a retrospective cohort study of the National Cancer Data Base Participant User File Breast 2014, which captures ~70%–80% of all newly diagnosed cancer cases in the United States. Female patients who were diagnosed with early stage breast adenocarcinoma (T0, T1, T1A, T1B, 2, 2A, or T2N1) from 2004 to 2014 were eligible for this study. RESULTS/ANTICIPATED RESULTS: A total of 807,314 patients were included in this study. Evidence-based guidelines examined with associated compliance rates include surgery completion (79.3% overall compliance), breast conserving surgery Versus mastectomy (88.05% vs. 11.95%, respectively), radiation after breast conserving surgery (77.5% overall compliance), HER2 testing (88.6% overall compliance), estrogen/progesterone receptor (ER/PR) testing (96.3% overall compliance), hormone treatment for positive ER/PR breast cancer (80.2% overall compliance), and sentinel lymph node biopsy completion (67.5% overall compliance). Univariate association between these guidelines and covariates such as facility type, facility location, age, race, insurance status, median income quartiles, achievement of high school degree, urban Versus rural, Charlson-Deyo score, year of diagnosis, and overall survival were assessed. Logistic regression analysis will be used to determine multivariate relationships between these characteristics and the probability that a patient will be compliant to guideline regimen. DISCUSSION/SIGNIFICANCE OF IMPACT: The results of this study will help identify socio-economic, clinical, and facility factors that influence guideline-concordant care and subsequent critical outcomes for patients with early stage breast cancer. Lack of guideline concordant care for specific stages of cancer or treatment modalities will point to a need for tailored interventions to enhance compliance. A prediction model will help identify the most important predictors of noncompliance in breast cancer treatment so noncompliance can be prevented in at-risk populations.

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Complications Associated With Use of Long-Term Central Venous Catheters Among Commercially Insured Women With Breast Cancer

Journal of Oncology Practice ◽

10.1200/jop.2015.004796 ◽

2015 ◽

Vol 11 (6) ◽

pp. 505-510 ◽

Cited By ~ 3

Author(s):

Allison Lipitz-Snyderman ◽

Qinli Ma ◽

Michael F. Pollack ◽

John Barron ◽

Elena B. Elkin ◽

...

Keyword(s):

Breast Cancer ◽

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous Catheters ◽

Evidence Based ◽

Central Venous ◽

Evidence Based Guidelines

Long-term central venous catheter (CVC) use is associated with increased morbidity. Evidence-based guidelines tools may help decrease discretionary use of long-term CVCs resulting from provider- or institution-driven variations in practice.

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Computerised evidence based guidelines in primary care: Interactive decision support is here and essential for 21st century primary care

BMJ ◽

10.1136/bmj.326.7398.1087-a ◽

2003 ◽

Vol 326 (7398) ◽

pp. 1087-a-1087

Author(s):

C. B Prince

Keyword(s):

Primary Care ◽

Decision Support ◽

21St Century ◽

Evidence Based ◽

Interactive Decision Support ◽

Evidence Based Guidelines

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Special considerations of breast cancer management in the elderly

Breast Cancer Management ◽

10.2217/bmt-2020-0023 ◽

2020 ◽

pp. BMT46

Author(s):

Lauren F Cornell ◽

Sarah A Mclaughlin ◽

Sandhya Pruthi ◽

Dawn M Mussallem

Keyword(s):

Breast Cancer ◽

Clinical Trials ◽

Elderly Patients ◽

Management Strategies ◽

The Elderly ◽

Evidence Based ◽

Limited Evidence ◽

Cancer Management ◽

Breast Cancer Management ◽

Evidence Based Guidelines

There are increasing numbers of elderly patients diagnosed with breast cancer. These patients are under-represented in available clinical trials, and as such, there are limited evidence-based guidelines for treatment in this population. Elderly patients have unique needs and management strategies should be tailored accordingly. This article reviews available literature regarding breast cancer management and special considerations in elderly patients.

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