scholarly journals Cost-Effectiveness of a Clinical Childhood Obesity Intervention

2018 ◽  
pp. 136-152
Author(s):  
Mona Sharifi ◽  
Calvin Franz ◽  
Christine M. Horan ◽  
Catherine M. Giles ◽  
Michael W. Long ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Cost Effectiveness ◽  
Childhood Obesity ◽  
Primary Care Providers ◽  
Obesity Prevalence ◽  
Care Providers ◽  
Obesity Intervention ◽  
National Implementation ◽  
Behavior Change Support

OBJECTIVES To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. METHODS In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. RESULTS The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention’s effect worsened the former. CONCLUSIONS A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence.

scholarly journals Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

2020 ◽  
Vol 11 (04) ◽  
pp. 635-643
Author(s):  
Joan S. Ash ◽  
Dian Chase ◽  
Sherry Baron ◽  
Margaret S. Filios ◽  
Richard N. Shiffman ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
Technical Feasibility ◽  
Primary Care Settings ◽  
Worker Health ◽  
Operational Issues

Abstract Background Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.

Appropriateness and Cost-Effectiveness of Echocardiograms Ordered by Pediatric Cardiologists and Primary Care Providers for Syncope

2021 ◽  
pp. 000992282110382
Author(s):  
Tracey M. Thompson ◽  
Ty E. Hasselman ◽  
Yanzhi Wang ◽  
David W. Jantzen
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Pediatric Cardiology ◽  
Cost Effective ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cost Effectiveness Ratio ◽  
Improve Cost Effectiveness ◽  
Cardiology Clinic ◽  
Improve Cost

The pediatric appropriate use criteria (AUC) were applied to transthoracic echocardiograms (TTE) ordered by primary care providers (PCPs) and pediatric cardiologists for the diagnosis of syncope to compare appropriateness ratings and cost-effectiveness. Included were patients ≤18 years of age from October 2016 to October 2018 with syncope who underwent initial outpatient pediatric TTE ordered by a PCP or were seen in Pediatric Cardiology clinic. Ordering rate of TTE by pediatric cardiologists, AUC classification, and TTE findings were obtained. PCPs ordered significantly more TTEs than pediatric cardiologists for “rarely appropriate” indications (61.5% vs 7.5%, P < .001). Cardiologists ordered TTEs at 17.2% of visits. Using appropriateness as a marker of effect, with the incremental cost-effectiveness ratio, it was more cost-effective ($543.33 per patient) to refer to a pediatric cardiologist than to order the TTE alone. This suggests that improved PCP education of the AUC and appropriate indications of TTEs for syncope may improve cost-effectiveness when using order appropriateness as a marker of effectiveness.

scholarly journals Adoption of an Electronic Medical Record Tool for Childhood Obesity by Primary Care Providers

2020 ◽  
Vol 11 (02) ◽  
pp. 210-217
Author(s):  
Amy Williams ◽  
Christy Turer ◽  
Jamie Smith ◽  
Isabelle Nievera ◽  
Laura McCulloch ◽  
...  
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Primary Care Providers ◽  
Perceived Usefulness ◽  
Intention To Use ◽  
Care Providers ◽  
Perceived Usability ◽  
Strongly Agree

Abstract Background Primary care providers are tasked with the increasingly difficult job of addressing childhood obesity during clinic visits. Electronic medical record (EMR)-enabled decision-support tools may aid providers in this task; however, information is needed regarding whether providers perceive such tools to be useful for addressing nutrition and physical activity lifestyle behaviors. Objectives This study aimed to evaluate the usefulness and usability of FitTastic, an EMR-enabled tool to support prevention and management of childhood obesity in primary care. Methods In this mixed-method study, we implemented the FitTastic tool in two primary-care clinics, then surveyed and conducted focused interviews with providers. Validated Technology Acceptance Model perceived usefulness and National Aeronautics and Space Administration (NASA) perceived usability survey questions were e-mailed to 60 providers. In-depth provider interviews with family medicine and pediatric physicians (n = 12) were used to further probe adoption of FitTastic. Results Surveys were completed by 73% of providers (n = 44). The mean score for FitTastic's usefulness was 3.3 (standard deviation [SD] = 0.54, scale 1–5, where 5 is strongly agree) and usability, 4.8 (SD = 0.86, scale 1–7, where 7 is strongly agree). Usefulness and usability scores were associated with intention to use FitTastic (correlation for both, p < 0.05). Data from provider interviews indicated that useful features of FitTastic included: standardizing the approach to childhood obesity, and facilitating conversations about weight management, without increasing cognitive workload. However, use of FitTastic required more time from nurses to input lifestyle data. Conclusion FitTastic is perceived as a useful and usable EMR-based lifestyle behavior tool that standardizes, facilitates, and streamlines healthy lifestyle conversations with families. Perceived usability and usefulness scores correlated with provider intention-to-use the technology. These data suggest that EMR-based child obesity prevention and management tools can be feasible to use in the clinic setting, with potential for scalability. Usefulness can be optimized by limiting amount of time needed by staff to input data.

scholarly journals Live Usability Testing of Two Complex Clinical Decision Support Tools: Observational Study (Preprint)

2018 ◽  
Author(s):  
Safiya Richardson ◽  
David Feldstein ◽  
Thomas McGinn ◽  
Linda S Park ◽  
Sundas Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Observational Study ◽  
Clinical Decision Support ◽  
Usability Testing ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Chief Complaint ◽  
Care Providers ◽  
Clinical Environment

BACKGROUND Potential of the electronic health records (EHR) and clinical decision support (CDS) systems to improve the practice of medicine has been tempered by poor design and the resulting burden they place on providers. CDS is rarely tested in the real clinical environment. As a result, many tools are hard to use, placing strain on providers and resulting in low adoption rates. The existing CDS usability literature relies primarily on expert opinion and provider feedback via survey. This is the first study to evaluate CDS usability and the provider-computer-patient interaction with complex CDS in the real clinical environment. OBJECTIVE This study aimed to further understand the barriers and facilitators of meaningful CDS usage within a real clinical context. METHODS This qualitative observational study was conducted with 3 primary care providers during 6 patient care sessions. In patients with the chief complaint of sore throat, a CDS tool built with the Centor Score was used to stratify the risk of group A Streptococcus pharyngitis. In patients with a chief complaint of cough or upper respiratory tract infection, a CDS tool built with the Heckerling Rule was used to stratify the risk of pneumonia. During usability testing, all human-computer interactions, including audio and continuous screen capture, were recorded using the Camtasia software. Participants’ comments and interactions with the tool during clinical sessions and participant comments during a postsession brief interview were placed into coding categories and analyzed for generalizable themes. RESULTS In the 6 encounters observed, primary care providers toggled between addressing either the computer or the patient during the visit. Minimal time was spent listening to the patient without engaging the EHR. Participants mostly used the CDS tool with the patient, asking questions to populate the calculator and discussing the results of the risk assessment; they reported the ability to do this as the major benefit of the tool. All providers were interrupted during their use of the CDS tool by the need to refer to other sections of the chart. In half of the visits, patients’ clinical symptoms challenged the applicability of the tool to calculate the risk of bacterial infection. Primary care providers rarely used the incorporated incentives for CDS usage, including progress notes and patient instructions. CONCLUSIONS Live usability testing of these CDS tools generated insights about their role in the patient-provider interaction. CDS may contribute to the interaction by being simultaneously viewed by the provider and patient. CDS can improve usability and lessen the strain it places on providers by being short, flexible, and customizable to unique provider workflow. A useful component of CDS is being as widely applicable as possible and ensuring that its functions represent the fastest way to perform a particular task.

scholarly journals Genomic decision support needs in pediatric primary care

2017 ◽  
Vol 24 (4) ◽  
pp. 851-856 ◽  
Author(s):  
Jeffrey W Pennington ◽  
Dean J Karavite ◽  
Edward M Krause ◽  
Jeffrey Miller ◽  
Barbara A Bernhardt ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Further Development

Abstract Clinical genome and exome sequencing can diagnose pediatric patients with complex conditions that often require follow-up care with multiple specialties. The American Academy of Pediatrics emphasizes the role of the medical home and the primary care pediatrician in coordinating care for patients who need multidisciplinary support. In addition, the electronic health record (EHR) with embedded clinical decision support is recognized as an important component in providing care in this setting. We interviewed 6 clinicians to assess their experience caring for patients with complex and rare genetic findings and hear their opinions about how the EHR currently supports this role. Using these results, we designed a candidate EHR clinical decision support application mock-up and conducted formative exploratory user testing with 26 pediatric primary care providers to capture opinions on its utility in practice with respect to a specific clinical scenario. Our results indicate agreement that the functionality represented by the mock-up would effectively assist with care and warrants further development.

scholarly journals Evaluation of the Effect of Decision Support on the Efficiency of Primary Care Providers in the Outpatient Practice

2014 ◽  
Vol 6 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Kavishwar B. Wagholikar ◽  
Ronald A. Hankey ◽  
Lindsay K. Decker ◽  
Stephen S. Cha ◽  
Robert A. Greenes ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Primary Care Providers ◽  
Care Providers ◽  
Outpatient Practice
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