Measuring quality in cancer care: Utilizing a clinical decision support system to assess pathway adherence.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 172-172
Author(s):  
Debra A. Patt ◽  
Josh Howell ◽  
Marcus A. Neubauer ◽  
Bo He ◽  
Jody S. Garey
Keyword(s):  
Quality Improvement ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Cancer Care ◽  
Clinical Decision ◽  
Data Capture ◽  
Post Intervention ◽  
Improvement Programs ◽  
Exception Reporting ◽  
Quality Improvement Programs

172 Background: Quality-based programs depend on clinical data documentation for reporting, treatment planning, and measuring pathways (PW) compliance. Adherence to treatment PW reduces variability and costs of care. Clinical decision support systems (CDSS) are tools embedded in the EHR to capture assessable data: stage, biomarkers, line of therapy, etc. With such data, CDSS can measure and report on clinical quality improvement programs like PW adherence, assessable data and exception reporting. Methods: A retrospective cohort study from Jan 1, 2014 - May 30, 2016 measured the impact of an integrated CDSS assessing compliance to PW and exception reporting across 9 independent oncology practices over a 9 month period. Assessable data, PW adherence, and exception reporting were tracked in 4 month intervals pre and post CDSS intervention by practice and physician. A one month wash out period was included post CDSS implementation. Overall rates of positivity, assessable data, and exception reporting were compared pre and post intervention using the Chi-square test. To account for the effect of time on the intervention, a segmented regression analysis was performed to analyze weekly rates of positivity pre and post intervention. Results: 9 practices, 633 physicians, and 30,666 treatment regimens were included. The weekly adherence rate increased by 7.2% after intervention (p = 0.005) across the group. Assessable data capture significantly improved across the cohort OR 6.79 (5.64-8.16) and individually for most practices. Physicians adherent to PW 75% of the time increased post intervention collectively, OR 1.83 (1.44-2.31), and individually. Exception reporting improved from 29% to 99% (p<0.0001). Conclusions: Across a cohort of community oncology practices rates of assessable data, PW adherence, and exception reporting improved after implementation of an integrated CDSS. Effective CDSSs are a critical component of quality improvement programs and may be used to improve data capture, increase adherence to PW and overall contribute to quality cancer care delivery. [Table: see text]

Driving quality improvement: How clinical decision support can facilitate compliance with evidence-based pathways.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2045-2045
Author(s):  
Debra A. Patt ◽  
Bo He ◽  
Jody S. Garey ◽  
Paul Rowan ◽  
Michael D Swartz ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Cancer Care ◽  
Care Delivery ◽  
Clinical Decision ◽  
Clinical Informatics ◽  
Evidence Based ◽  
Large Network ◽  
The Impact

2045 Background: Cancer care is changing rapidly with more detailed understanding of disease and more numerous therapeutic choices. As treatment choice is more complex, mechanisms to improve compliance with evidence based treatment can improve the quality of cancer care. Methods: A retrospective cohort study was conducted from January 2014-May 2016 evaluating the impact of a clinical decision support system (CDSS) on compliance with evidence based pathways (EBP) across 9 statewide community based oncology practices. These EBP are developed with physician input on efficacy toxicity and value and incorporated in to a CDSS that is used within the Electronic Health Record (EHR) at point of care to alter the choice architecture a clinician sees when prescribing therapy. A multi-level logistic regression model was used to adjust for group effects on physician or practice behavior. SAS 9.4 software was used and GLIMMIX was applied. Individual physician benchmark compliance was evaluated using McNemar's test. Results: Regimen compliance with EBP was measured pre- and post- implementation of the CDSS tool across a large network encompassing 9 statewide practices and 633 physicians who prescribed over 30,000 individual patient treatment regimens over a 6 month period. The CDSS that is incorporated within the EHR significantly improved compliance with EBP across the entire cohort of practices, and in individual practices (see Table). Individual oncologists reached a target of 75% compliance more often (58% vs 72%) after implementation of the tool (p < 0.001). Conclusions: CDSS is a tool that improves compliance with EBP that is effective at improving targets of compliance broadly, at the practice, and at the individual clinician level. Clinical informatics solutions that influence physician behavior can be inclusive of physicians in design, iterative in process, and nudge as opposed to force clinician behavior to drive quality improvement. These clinical informatics solutions grow in importance as the complexity of cancer care continues to increase and we seek to improve upon the quality and value of care delivery. [Table: see text]

scholarly journals Sinusitis Treatment Guideline Adherence in the e-visit Setting

2016 ◽  
Vol 07 (02) ◽  
pp. 299-307
Author(s):  
Dang Tran ◽  
Bonnie Westra ◽  
Kevin Smith
Keyword(s):  
Quality Improvement ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Guideline Adherence ◽  
Clinical Guideline ◽  
Clinical Decision ◽  
Care Providers ◽  
Post Intervention ◽  
Improvement Project ◽  
Time Period

SummaryStudies demonstrate poor guideline adherence by health care providers for the treatment of upper respiratory infections, particularly acute bacterial rhinosinusitis (ABRS), in the appropriate prescribing of antibiotic medications.The purpose of this quality improvement project was to evaluate the effect of implementing interventions for improving adherence to a clinical practice guideline for the management of ABRS for patients treated in the e-visit setting. Interventions included: providing a report to providers of their adherence to the ABRS clinical guideline prior to the intervention, providing updated education on the ABRS guideline, and implementing a clinical decision support system reminder.A pre and post intervention evaluation design was used. Data were obtained from a retrospective electronic health record (EHR) data extract of all 316 diagnoses for ABRS in the preintervention 2-month time period and all 368 diagnoses of ABRS in the post-intervention 2-month time period. A review of the structured clinical data elements was performed to determine whether the provider adhered to the clinical guideline, meaning that only patients meeting the criteria for ABRS were to receive an antibiotic prescription.The interventions resulted in a 3.3% improvement in adherence to the ABRS clinical guideline from 95.25% adherence pre-intervention to 98.4% post-intervention. These results demonstrated that the use of an educational intervention and clinical decision support resulted in improved adherence to the ABRS clinical guideline in the e-visit setting. The implications for practice could be significant in that these quality improvement interventions improve guideline adherence and reduce unnecessary prescribing of antibiotics.

scholarly journals A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines

2021 ◽  
Author(s):  
Tessa Jaspers ◽  
Marjolijn Duisenberg-van Essenberg ◽  
Barbara Maat ◽  
Marc Durian ◽  
Roy van den Berg ◽  
...  
Keyword(s):  
Decision Support ◽  
Venous Thromboembolism ◽  
Clinical Decision Support ◽  
Guideline Adherence ◽  
Intervention Group ◽  
Clinical Decision ◽  
Multifaceted Intervention ◽  
Annual Number ◽  
Post Intervention ◽  
Mobile Phone Application

AbstractBackground Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low. Objective To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented. Setting A Dutch general teaching hospital. Method A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients. Main outcome measure Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements. Results 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4 to 82.4% (OR 4.78; 95%CI 2.37–9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5 to 84.3% (OR 2.46; 95%CI 1.31–4.62), resulting in the potential prevention of ± 261 venous thromboembolisms per year. Conclusions Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence.

scholarly journals Quality of the documentation of the Nursing process in clinical decision support systems

2021 ◽  
Vol 29 ◽  
Author(s):  
Neurilene Batista de Oliveira ◽  
Heloísa Helena Ciqueto Peres
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
P Value ◽  
Nursing Process ◽  
Post Intervention ◽  
Quasi Experimental ◽  
Process Documentation

Objective: to compare the quality of the Nursing process documentation in two versions of a clinical decision support system. Method: a quantitative and quasi-experimental study of the before-and-after type. The instrument used to measure the quality of the records was the Brazilian version of the Quality of Diagnoses, Interventions and Outcomes, which has four domains and a maximum score of 58 points. A total of 81 records were evaluated in version I (pre-intervention), as well as 58 records in version II (post-intervention), and the scores obtained in the two applications were compared. The interventions consisted of planning, pilot implementation of version II of the system, training and monitoring of users. The data were analyzed in the R software, using descriptive and inferential statistics. Results: the mean obtained at the pre-intervention moment was 38.24 and, after the intervention, 46.35 points. There was evidence of statistical difference between the means of the pre- and post-intervention groups, since the p-value was below 0.001 in the four domains evaluated. Conclusion: the quality of the documentation of the Nursing process in version II of the system was superior to version I. The efficacy of the system and the effectiveness of the interventions were verified. This study can contribute to the quality of documentation, care management, visibility of nursing actions and patient safety.

scholarly journals P036: A clinical decision support intervention to increase usage of probenecid in the ED

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S90-S90
Author(s):  
S. Dowling ◽  
E. Lang ◽  
D. Wang ◽  
T. Rich
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Soft Tissue ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Soft Tissue Infections ◽  
Post Intervention ◽  
Support Intervention ◽  
Intervention Phase ◽  
Decision Support Intervention

Introduction: In certain circumstances, skin and soft tissue infections are managed with intravenous (IV) antibiotics. In our center, patients initiated on outpatient IV antibiotics are followed up by a home parental therapy program the following day. A significant number of these patients require a repeat visit to the ED because of clinic hours. Probenecid is a drug that can prolong the half-life of certain antibiotics (such as cefazolin) and can therefore avoid a repeat ED visit, reducing health care costs and improve ED capacity. Our goal was to increase probenecid usage in the ED in order to optimize management of skin and soft tissue infections (SSTI) in the ED. The primary outcome was to compare the usage of probenecid in the pre and post-intervention phase. Secondary outcomes were to compare revisit rates between patients receiving cefazolin alone vs cefazolin + probenecid. Methods: Using administrative data merged with Computerized Physician Order Entry (CPOE), we extracted data 90 days pre- and 90 post-intervention (February 11, 2015 to August 11, 2015). The setting for the study is an urban center (4 adult ED’s with an annual census of over 320,000 visits per year). Our CPOE system is fully integrated into the ED patient care. The multi-faceted intervention involved modifying all relevant SSTI order sets in the CPOE system to link any cefazolin order with an order for probenecid. Physicians and nurses were provided with a 1 page summary of probenecid (indications, contra-indications, pharmacology), as well as decision support with the CPOE. Any patients who were receiving outpatient cefazolin therapy were included in the study. Results: Our analysis included 2512 patients (1148 and 1364 patients in the pre/post phases) who received cefazolin in the ED and were discharged during the 180 day period. Baseline variables (gender, age, % admitted) and ED visits were similar in both phases. In the pre-intervention phase 30.2% of patients received probenecid and in the post-intervention phase 43.0%, for a net increase of 12.8% (p=<0.0001). Patients who received probenecid had a 2.2% (11.4% vs 13.6%, p=0.014) lower re-visit rate in the following 72H. Conclusion: We have implemented a CPOE based clinical decision support intervention that demonstrated significant increase in probenecid usage by emergency physician and resulted in a decrease in ED revisits. This intervention would result in health care cost-savings.

scholarly journals Implementation of clinical decision support to manage acute kidney injury in secondary care: an ethnographic study

2019 ◽  
Vol 29 (5) ◽  
pp. 382-389
Author(s):  
Simon Bailey ◽  
Carianne Hunt ◽  
Adam Brisley ◽  
Susan Howard ◽  
Lynne Sykes ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Patient Safety ◽  
Quality Improvement ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Kidney Injury ◽  
Clinical Decision ◽  
Ethnographic Study ◽  
Routine Practice ◽  
Trade Offs

BackgroundOver the past decade, acute kidney injury (AKI) has become a global priority for improving patient safety and health outcomes. In the UK, a confidential inquiry into AKI led to the publication of clinical guidance and a range of policy initiatives. National patient safety directives have focused on the mandatory establishment of clinical decision support systems (CDSSs) within all acute National Health Service (NHS) trusts to improve the detection, alerting and response to AKI. We studied the organisational work of implementing AKI CDSSs within routine hospital care.MethodsAn ethnographic study comprising non-participant observation and interviews was conducted in two NHS hospitals, delivering AKI quality improvement programmes, located in one region of England. Three researchers conducted a total of 49 interviews and 150 hours of observation over an 18-month period. Analysis was conducted collaboratively and iteratively around emergent themes, relating to the organisational work of technology adoption.ResultsThe two hospitals developed and implemented AKI CDSSs using very different approaches. Nevertheless, both resulted in adaptive work and trade-offs relating to the technology, the users, the organisation and the wider system of care. A common tension was associated with attempts to maximise benefit while minimise additional burden. In both hospitals, resource pressures exacerbated the tensions of translating AKI recommendations into routine practice.ConclusionsOur analysis highlights a conflicted relationship between external context (policy and resources), and organisational structure and culture (eg, digital capability, attitudes to quality improvement). Greater consideration is required to the long-term effectiveness of the approaches taken, particularly in light of the ongoing need for adaptation to incorporate new practices into routine work.

scholarly journals Opportunities for Quality Improvement Programs (QIPs) in the Nutrition Support of Patients with Cancer

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 227 ◽  
Author(s):  
Mary Beth Arensberg ◽  
Julie Richards ◽  
Jyoti Benjamin ◽  
Kirk Kerr ◽  
Refaat Hegazi
Keyword(s):  
Quality Improvement ◽  
Health Outcomes ◽  
Cancer Care ◽  
Nutrition Support ◽  
Oral Nutrition ◽  
Patients With Cancer ◽  
Treatment Interruptions ◽  
Improvement Programs ◽  
Quality Improvement Programs

Malnutrition in patients with cancer is a ubiquitous but neglected problem that can reduce patient survival/quality of life and increase treatment interruptions, readmission rates, and healthcare costs. Malnutrition interventions, including nutrition support through dietary counseling, diet fortification, oral nutrition supplements (ONS), and enteral and parenteral nutrition can help improve health outcomes. However, nutritional care standards and interventions for cancer are ambiguous and inconsistently applied. The lack of systematic malnutrition screening and intervention in ambulatory cancer care has especially significant consequences and thus the nutrition support of patients with cancer represents an area for quality improvement. United States healthcare payment models such as the Oncology Care Model are linked to quality of care and health outcomes. Quality improvement programs (QIPs) can advance patient-centered care, perfect care processes, and help healthcare professionals meet their quality measure performance goals. Malnutrition QIPs like the Malnutrition Quality Improvement Initiative (MQii) have been shown to be effective in identifying and treating malnutrition. However, little is known about or has been reported on nutrition or malnutrition-focused QIPs in cancer care. This paper provides information to support translational research on quality improvement and outlines the gaps and potential opportunities for QIPs in the nutrition support of patients with cancer.

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