Abstract P305: Assessing the Feasibility of Implementing a Clinical Decision Support Tool in the Office-Based Setting: Experiences From the American College of Cardiology's Improving Continuous Cardiac Care (IC3) Pilot Program

BACKGROUND: Clinical decision support tools have been used to improve guideline adherence amidst challenges during implementation in the office-based setting. As such, these tools require pilot testing to assess feasibility and ease of use. METHODS: The IC 3 Program, now known as the PINNACLE Registry, is a prospective, practice-based QI program designed to capture and report outpatient performance measures (PM) and provide decision support tools to optimize the quality of care delivered to outpatient cardiac patients. ACC/AHA guidelines and PMs for CAD, atrial fibrillation, heart failure and hypertension were translated into key data elements collected systematically via a paper-based data collection form (DCF). In September 2008, four offices participated in a 2-week pilot to assess the feasibility of implementing the DCF. A self-reported survey was administered, followed by a phone interview with participants. RESULTS: Results of the implementation pilot found that all respondents agreed with the overall layout of the DCF and that the data collected were typical of that routinely collected during a patient encounter. Physicians completed the DCFs more often( 57.1%) than other staff in the office. However, nurses or other staff(80%) were more likely to fax the data into the ACC. DCFs were faxed generally at the end of the week (66.7%). Most practices entered data both during and after the patient encounter (60%). Time for data entry ranged from 10-20 minutes. Roughly, half of the participants found data collection easy and others found it time consuming. One physician suggested making changes in the office work flow for future data collection. CONCLUSION: The pilot of the DCF provided valuable insight regarding the feasibility of collecting and reporting data, as well as the usability of a paper-based DCF in the outpatient setting. Although challenging, implementation of a paper-based decision support tool in practices can be successful. These findings demonstrate that it takes a team effort with clear delineation of roles and responsibilities to insure practice-wide adoption of a systematic QI process for accurately collecting and reporting clinical data.