An Analytics Framework for Physician Adherence to Clinical Practice Guidelines: Knowledge-Based Approach (Preprint)

2018 ◽  
Author(s):  
Jaehoon Lee ◽  
Nathan C Hulse
Keyword(s):  
Clinical Practice ◽  
Knowledge Base ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Visual Analytics ◽  
Process Models ◽  
Care Process ◽  
Knowledge Based ◽  
Clinical Databases ◽  
Knowledge Content

BACKGROUND One of the problems in evaluating clinical practice guidelines (CPGs) is the occurrence of knowledge gaps. These gaps may occur when evaluation logics and definitions in analytics pipelines are translated differently. OBJECTIVE The objective of this paper is to develop a systematic method that will fill in the cognitive and computational gaps of CPG knowledge components in analytics pipelines. METHODS We used locally developed CPGs that resulted in care process models (CPMs). We derived adherence definitions from the CPMs, transformed them into computationally executable queries, and deployed them into an enterprise knowledge base that specializes in managing clinical knowledge content. We developed a visual analytics framework, whose data pipelines are connected to queries in the knowledge base, to automate the extraction of data from clinical databases and calculation of evaluation metrics. RESULTS In this pilot study, we implemented 21 CPMs within the proposed framework, which is connected to an enterprise data warehouse (EDW) as a data source. We built a Web–based dashboard for monitoring and evaluating adherence to the CPMs. The dashboard ran for 18 months during which CPM adherence definitions were updated a number of times. CONCLUSIONS The proposed framework was demonstrated to accommodate complicated knowledge management for CPM adherence evaluation in analytics pipelines using a knowledge base. At the same time, knowledge consistency and computational efficiency were maintained.

Data-Driven Approaches for Developing Clinical Practice Guidelines

2017 ◽  
pp. 1307-1323
Author(s):  
Yiye Zhang ◽  
Rema Padman
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Visual Analytics ◽  
Process Mining ◽  
Clinical Pathways ◽  
Workflow Management ◽  
Machine Learning Algorithms ◽  
Data Driven ◽  
Statistical Process

This chapter discusses clinical practice guidelines (CPGs) and their incorporation into healthcare IT (HIT) applications. CPGs provide guidance on treatment options based on evidence. This chapter provides a brief background on challenges in CPG development and adherence, and offers examples of data-driven approaches to improve usability of CPGs and their applications in HIT. A focus is given to clinical pathways, which translate CPG recommendations into actionable plans for patient management in community practices. Approaches for developing data-driven clinical pathways from electronic health record data are presented, including statistical, process mining, and machine learning algorithms. Further, efforts on using CPGs for decision support through visual analytics, and deployments of CPGs into mobile applications are described. Data-driven approaches can facilitate incorporation of practice-based evidence into CPG development after validation by clinical experts, potentially bridging the gap between available CPGs and changing clinical needs and workflow management.

Data-Driven Approaches for Developing Clinical Practice Guidelines

2017 ◽  
pp. 30-46 ◽  
Author(s):  
Yiye Zhang ◽  
Rema Padman
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Visual Analytics ◽  
Process Mining ◽  
Clinical Pathways ◽  
Workflow Management ◽  
Machine Learning Algorithms ◽  
Data Driven ◽  
Statistical Process

This chapter discusses clinical practice guidelines (CPGs) and their incorporation into healthcare IT (HIT) applications. CPGs provide guidance on treatment options based on evidence. This chapter provides a brief background on challenges in CPG development and adherence, and offers examples of data-driven approaches to improve usability of CPGs and their applications in HIT. A focus is given to clinical pathways, which translate CPG recommendations into actionable plans for patient management in community practices. Approaches for developing data-driven clinical pathways from electronic health record data are presented, including statistical, process mining, and machine learning algorithms. Further, efforts on using CPGs for decision support through visual analytics, and deployments of CPGs into mobile applications are described. Data-driven approaches can facilitate incorporation of practice-based evidence into CPG development after validation by clinical experts, potentially bridging the gap between available CPGs and changing clinical needs and workflow management.

Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines:

2002 ◽  
Vol 68 (1-3) ◽  
pp. 59-70 ◽  
Author(s):  
Dongwen Wang ◽  
Mor Peleg ◽  
Samson W Tu ◽  
Aziz A Boxwala ◽  
Robert A Greenes ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Patient Data ◽  
Process Models

Implementation of clinical practice guidelines in a multicenter radiation oncology department.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 117-117
Author(s):  
Sewit Teckie ◽  
Lucille Lee ◽  
Henry Chou ◽  
Petrina Zuvic ◽  
Louis Potters
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Radiation Oncology ◽  
Cancer Care ◽  
Clinical Care ◽  
Care Process ◽  
Standards Of Care ◽  
Cancer Site ◽  
Evidence Based

117 Background: Recent reports suggest that less than 20% of cancer care is based upon level I evidence. As a result, the majority of cancer care tends to be ad-hoc. Furthermore, deviations from established standards-of-care are associated with worse clinical outcomes. Systematic and evidence-based approaches to cancer care are widely regarded as an effective way of improving quality and value in oncology, yet their implementation remains broadly circumspect. In our multicenter radiation medicine department, we developed clinical practice guidelines (CPGs) that encourage consistent care in order to minimize variations in patient treatment, outcome, and experience. We hypothesized that CPGs would also improve efficiency, performance, and cost. Methods: We developed a system for prioritizing value in radiation oncology (Smarter Radiation Oncology) comprising three pillars – quality, evidence-based care, and patient experience. We created 87 unique, evidence-based and consensus-driven electronic CPGs that apply to the majority of patients undergoing radiation therapy in our department. Each CPG delineates an evidence-based treatment approach for a specific cancer site and stage, as well as many technical components such as simulation, treatment planning, quality assurance, clinical care requirements and survivorship. Results: Overall compliance to CPGs was >88%. Six-sigma Z-scores indicated improvement in efficiency and compliance. Treatment delays decreased and patients reported more favorable ratings on a variety of measures, including likelihood to recommend, wait times, understanding of treatment, and physician sensitivity. For breast and prostate cancer, adherence to CPG treatment resulted in 20% and 15% average lower costs than standard, non-CPG treatment. Conclusions: We demonstrate that consensus- and evidence-based CPGs can be successfully implemented in a multicenter department, with high adherence rates. CPGs improve safety and reduce costs by minimizing variation and deviations from standards-of-care. In an era of rising cancer spending, CPGs can be expanded beyond radiation oncology to the entire oncologic care process, thereby improving value for all cancer patients.

High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

2020 ◽  
Vol 5 (4) ◽  
pp. 1006-1010
Author(s):  
Jennifer Raminick ◽  
Hema Desai
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Oxygen Therapy ◽  
Respiratory Illness ◽  
High Flow ◽  
Oral Feeding ◽  
Respiratory Support ◽  
Acute Respiratory Illness ◽  
High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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