scholarly journals Incorporating Guideline Adherence and Practice Implementation Issues into the Design of Decision Support for Beta-Blocker Titration for Heart Failure

2018 ◽  
Vol 09 (02) ◽  
pp. 478-489 ◽  
Author(s):  
Michael Smith ◽  
Charnetta Brown ◽  
Salim Virani ◽  
Charlene Weir ◽  
Laura Petersen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Support ◽  
Ejection Fraction ◽  
Decision Support Tool ◽  
Cognitive Demands ◽  
Support Tool ◽  
Usability Assessment ◽  
Clinical Reminder ◽  
Patients At Risk ◽  
Β Blocker

Background The recognition of and response to undertreatment of heart failure (HF) patients can be complicated. A clinical reminder can facilitate use of guideline-concordant β-blocker titration for HF patients with depressed ejection fraction. However, the design must consider the cognitive demands on the providers and the context of the work. Objective This study's purpose is to develop requirements for a clinical decision support tool (a clinical reminder) by analyzing the cognitive demands of the task along with the factors in the Cabana framework of physician adherence to guidelines, the health information technology (HIT) sociotechnical framework, and the Promoting Action on Research Implementation in Health Services (PARIHS) framework of health services implementation. It utilizes a tool that extracts information from medical records (including ejection fraction in free text reports) to identify qualifying patients at risk of undertreatment. Methods We conducted interviews with 17 primary care providers, 5 PharmDs, and 5 Registered Nurses across three Veterans Health Administration outpatient clinics. The interviews were based on cognitive task analysis (CTA) methods and enhanced through the inclusion of the Cabana, HIT sociotechnical, and PARIHS frameworks. The analysis of the interview data led to the development of requirements and a prototype design for a clinical reminder. We conducted a small pilot usability assessment of the clinical reminder using realistic clinical scenarios. Results We identified organizational challenges (such as time pressures and underuse of pharmacists), knowledge issues regarding the guideline, and information needs regarding patient history and treatment status. We based the design of the clinical reminder on how to best address these challenges. The usability assessment indicated the tool could help the decision and titration processes. Conclusion Through the use of CTA methods enhanced with adherence, sociotechnical, and implementation frameworks, we designed a decision support tool that considers important challenges in the decision and execution of β-blocker titration for qualifying HF patients at risk of undertreatment.

scholarly journals Factors Affecting Health Care Engagement of Patients With End-Stage Heart Failure: An Exploratory Survey Study

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831986551
Author(s):  
Lisa Carey Lohmueller ◽  
Aakanksha Naik ◽  
Luke Breitfeller ◽  
Colleen K. McIlvennan ◽  
Manreet Kanwar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Decision Making ◽  
Decision Support ◽  
Information Seeking ◽  
Decision Support Tool ◽  
Treatment Decisions ◽  
Support Tool ◽  
End Stage Heart Failure ◽  
End Stage

Background. The decision to receive a permanent left ventricular assist device (LVAD) to treat end-stage heart failure (HF) involves understanding and weighing the risks and benefits of a highly invasive treatment. The goal of this study was to characterize end-stage HF patients across parameters that may affect their decision making and to inform the development of an LVAD decision support tool. Methods. A survey of 35 end-stage HF patients at an LVAD implant hospital was performed to characterize their information-seeking habits, interaction with physicians, technology use, numeracy, and concerns about their health. Survey responses were analyzed using descriptive statistics, grounded theory method, and Bayesian network learning. Results. Most patients indicated an interest in using some type of decision support tool (roadmap of health progression: 46%, n = 16; personal prognosis: 51%, n = 18; short videos of patients telling stories of their experiences with an LVAD: 57%, n = 20). Information patients desired in a hypothetical decision support tool fell into the following topics: prognoses for health outcomes, technical information seeking, expressing emotions, and treatment decisions. Desire for understanding their condition was closely related to whether they had difficult interpreting their electronic medical record in the past. Conclusions. Most patients reported interest in engaging in their health care decision making and seeing their prognosis and electronic health record information. Patients who were less interested in their own treatment decisions were characterized by having less success understanding their health information. Design of a decision support tool for potential LVAD patients should consider a spectrum of health literacy and include information beyond the technical specifications of LVAD support.

scholarly journals Randomized, Controlled Trial of an Advance Care Planning Video Decision Support Tool for Patients With Advanced Heart Failure

Circulation ◽  
2016 ◽  
Vol 134 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Areej El-Jawahri ◽  
Michael K. Paasche-Orlow ◽  
Dan Matlock ◽  
Lynne Warner Stevenson ◽  
Eldrin F. Lewis ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trial ◽  
Decision Support ◽  
Controlled Trial ◽  
Decision Support Tool ◽  
Advanced Heart Failure ◽  
Care Planning ◽  
Support Tool ◽  
Randomized Controlled ◽  
Advance Care

scholarly journals Development, implementation, and evaluation of a clinical decision support tool to improve naloxone coprescription within military health system pharmacies

2021 ◽  
Author(s):  
Alexander Rittel ◽  
Krista Highland ◽  
Mark S Maneval ◽  
Archie Bockhorst ◽  
Agustin Moreno ◽  
...  
Keyword(s):  
At Risk ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Opioid Overdose ◽  
Military Health System ◽  
Military Health ◽  
Support Tool ◽  
Patients At Risk

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe the development, implementation, and evaluation of a pharmacy clinical decision support tool designed to increase naloxone coprescription among people at risk for opioid overdose in a large healthcare system. Summary The Military Health System Opioid Registry and underlying presentation layer were used to develop a clinical decision support capability to improve naloxone coprescription at the pharmacy point of care. Pharmacy personnel use a patient identification card barcode scanner or manually enter a patient’s identification number to quickly visualize information on a patient’s risk for opioid overdose and medical history related to pain and, when appropriate, receive a recommendation to coprescribe naloxone. The tool was made available to military treatment facility pharmacy locations. An interactive dashboard was developed to support monitoring, utilization, and impact on naloxone coprescription to patients at risk for opioid overdose. Conclusion Initial implementation of the naloxone tool was slow from a lack of end-user awareness. Efforts to increase utilization were, in part, successful owing to a number of enterprise-wide educational initiatives. In early 2020, the naloxone tool was used in 15% of all opioid prescriptions dispensed at a military pharmacy. Data indicate that the frequency of naloxone coprescription to patients at risk for opioid overdose was significantly higher when the naloxone tool was used than when the tool was not used.

scholarly journals Impact of electronic clinical decision support on adherence to guideline-recommended treatment for hyperlipidaemia, atrial fibrillation and heart failure: protocol for a cluster randomised trial

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e019087 ◽  
Author(s):  
Maya Elizabeth Kessler ◽  
Rickey E Carter ◽  
David A Cook ◽  
Daryl Jon Kor ◽  
Paul M McKie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Primary Outcome ◽  
Point Of Care ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Support Tool ◽  
Clinical Decision Support Tool

IntroductionClinical practice guidelines facilitate optimal clinical practice. Point of care access, interpretation and application of such guidelines, however, is inconsistent. Informatics-based tools may help clinicians apply guidelines more consistently. We have developed a novel clinical decision support tool that presents guideline-relevant information and actionable items to clinicians at the point of care. We aim to test whether this tool improves the management of hyperlipidaemia, atrial fibrillation and heart failure by primary care clinicians.Methods/analysisClinician care teams were cluster randomised to receive access to the clinical decision support tool or passive access to institutional guidelines on 16 May 2016. The trial began on 1 June 2016 when access to the tool was granted to the intervention clinicians. The trial will be run for 6 months to ensure a sufficient number of patient encounters to achieve 80% power to detect a twofold increase in the primary outcome at the 0.05 level of significance. The primary outcome measure will be the percentage of guideline-based recommendations acted on by clinicians for hyperlipidaemia, atrial fibrillation and heart failure. We hypothesise care teams with access to the clinical decision support tool will act on recommendations at a higher rate than care teams in the standard of care arm.Ethics and disseminationThe Mayo Clinic Institutional Review Board approved all study procedures. Informed consent was obtained from clinicians. A waiver of informed consent and of Health Insurance Portability and Accountability Act (HIPAA) authorisation for patients managed by clinicians in the study was granted. In addition to publication, results will be disseminated via meetings and newsletters.Trial registration numberNCT02742545.

Abstract P136: Identifying Opportunities to Further Improve Outcomes for Patients With Coronary Artery Disease and Heart Failure in a Managed Care Organization

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Courtney O Jordan ◽  
Thomas E Kottke
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Heart Disease ◽  
Decision Support ◽  
Decision Support Tool ◽  
Medical Group ◽  
National Data ◽  
Support Tool ◽  
Chronic Heart Disease ◽  
St Elevation

Background: We have created and evaluated a decision support tool to identify opportunities to improve outcomes for patients with coronary heart disease and heart failure (CAD/HF). Applying national data, we concluded that improving care for patients with chronic disease would generate the greatest improvement in outcomes. The purpose of this analysis is two-fold: 1) to determine whether the decision support tool can be applied to data available from a “real” medical group, and 2) to determine whether the conclusions generated from analysis of the medical group data are similar to the conclusions generated from U.S. data. Methods: We created the tool to calculate the number of deaths that might be prevented or postponed if care for heart disease prevention and treatment were improved from current levels to optimal care_that is, the elimination of risk factors and the prescription of all effective medications before and between acute events, and the delivery of all effective therapies to individuals during an acute event. In this analysis we focus on calculating the impact of optimizing care for 40-74 year old patients treated for CAD/HF in a HealthPartners Medical Group (HPMG) clinic or at Regions Hospital between August 8, 2007 and July 31, 2008. Results: Condition or Event Deaths Prevented or Postponed by Optimizing Care Chronic heart disease with EF >35% 39 Chronic heart disease with EF <=35% 20 Myocardial infarction with ST elevation 1 Myocardial infarction without ST elevation 1 Unstable angina/other acute heart disease 3 Acute heart failure with EF <35% 10 New ambulatory or incidental diagnosis 10 Conclusions: This study demonstrates that 1) it is feasible to use our decision support tool to identify opportunities to improve outcomes for patients of a medical group, and that 2) as we concluded from the analysis of national data, the greatest opportunities to improve outcomes for patients with CAD/HF treated by this medical group lie with patients who are between acute events.

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