scholarly journals Use and Evaluation of Computerized Clinical Decision Support Systems for Early Detection of Sepsis in Hospitals: Protocol for a Scoping Review (Preprint)

2020 ◽  
Author(s):  
Ling Li ◽  
Khalia Ackermann ◽  
Jannah Baker ◽  
Johanna Westbrook
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Early Detection ◽  
Clinical Decision Support ◽  
Scoping Review ◽  
Clinical Decision ◽  
Evidence Base ◽  
Current Evidence ◽  
Scoping Reviews ◽  
Current Evidence Base

BACKGROUND Sepsis is a leading cause of death in hospitals, with high associated costs for both patients and health care systems worldwide. Early detection followed by timely intervention is critical for successful sepsis management and, hence, can save lives. Health care institutions are increasingly leveraging clinical data captured in electronic health records for the development of <i>computerized clinical decision support</i> (CCDS) systems aimed at enhancing the early detection of sepsis. However, a comprehensive evidence base regarding sepsis CCDS systems to inform clinical practice, research, and policy is currently lacking. OBJECTIVE This scoping review aims to systematically describe studies reporting on the use and evaluation of CCDS systems for early detection of sepsis in hospitals. METHODS The methodology for conducting scoping reviews presented by the Joanna Briggs Institute Reviewer’s Manual and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) will be used and adapted as guides. A comprehensive literature search of 10 electronic databases will be conducted to identify all empirical quantitative and qualitative studies that investigate the use of CCDS systems for early detection of sepsis in hospitals. Detailed inclusion and exclusion criteria have been developed. Two reviewers will independently screen all articles based on these criteria. Any discrepancies will be resolved through discussion and further review by a third researcher if required. RESULTS Electronic database searches have retrieved 12,139 references after removing 10,051 duplicates. As of the submission date of this protocol, we have completed the title and abstract screening. A total of 372 references will be included for full-text screening. Only 15.9% (59/372) of these studies were focused on children: 11.0% (41/372) for pediatric and 4.8% (18/372) for neonatal patients. The scoping review and the manuscript will be completed by December 2020. CONCLUSIONS Results of this review will guide researchers in determining gaps and shortcomings in the current evidence base for CCDS system use and evaluation in the early detection of sepsis. The findings will be shared with key stakeholders in clinical care, research, policy, and patient advocacy. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/24899

scholarly journals Use and Evaluation of Computerized Clinical Decision Support Systems for Early Detection of Sepsis in Hospitals: Protocol for a Scoping Review

10.2196/24899 ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. e24899
Author(s):  
Ling Li ◽  
Khalia Ackermann ◽  
Jannah Baker ◽  
Johanna Westbrook
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Early Detection ◽  
Clinical Decision Support ◽  
Scoping Review ◽  
Clinical Decision ◽  
Evidence Base ◽  
Current Evidence ◽  
Scoping Reviews ◽  
Current Evidence Base

Background Sepsis is a leading cause of death in hospitals, with high associated costs for both patients and health care systems worldwide. Early detection followed by timely intervention is critical for successful sepsis management and, hence, can save lives. Health care institutions are increasingly leveraging clinical data captured in electronic health records for the development of computerized clinical decision support (CCDS) systems aimed at enhancing the early detection of sepsis. However, a comprehensive evidence base regarding sepsis CCDS systems to inform clinical practice, research, and policy is currently lacking. Objective This scoping review aims to systematically describe studies reporting on the use and evaluation of CCDS systems for early detection of sepsis in hospitals. Methods The methodology for conducting scoping reviews presented by the Joanna Briggs Institute Reviewer’s Manual and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) will be used and adapted as guides. A comprehensive literature search of 10 electronic databases will be conducted to identify all empirical quantitative and qualitative studies that investigate the use of CCDS systems for early detection of sepsis in hospitals. Detailed inclusion and exclusion criteria have been developed. Two reviewers will independently screen all articles based on these criteria. Any discrepancies will be resolved through discussion and further review by a third researcher if required. Results Electronic database searches have retrieved 12,139 references after removing 10,051 duplicates. As of the submission date of this protocol, we have completed the title and abstract screening. A total of 372 references will be included for full-text screening. Only 15.9% (59/372) of these studies were focused on children: 11.0% (41/372) for pediatric and 4.8% (18/372) for neonatal patients. The scoping review and the manuscript will be completed by December 2020. Conclusions Results of this review will guide researchers in determining gaps and shortcomings in the current evidence base for CCDS system use and evaluation in the early detection of sepsis. The findings will be shared with key stakeholders in clinical care, research, policy, and patient advocacy. International Registered Report Identifier (IRRID) PRR1-10.2196/24899

Computerized Clinical Decision Support Systems for Early Detection of Sepsis Among Adult Inpatients: a Scoping Review (Preprint)

2021 ◽  
Author(s):  
Khalia Ackermann ◽  
Jannah Baker ◽  
Malcolm Green ◽  
Mary Fullick ◽  
Hilal Varinli ◽  
...  
Keyword(s):  
Decision Support ◽  
Early Detection ◽  
Patient Outcomes ◽  
Clinical Decision Support ◽  
Scoping Review ◽  
Full Text ◽  
Clinical Decision ◽  
Future Research ◽  
Eligibility Criteria ◽  
Full Text Screening

BACKGROUND Sepsis is a significant cause of morbidity and mortality worldwide. Early detection of septic patients followed by rapid treatment initiation improves patient outcomes and saves lives. Hospitals are increasingly utilizing computerized clinical decision support (CCDS) systems for the rapid identification of adult septic patients. OBJECTIVE This scoping review aimed to systematically describe studies reporting on the use and evaluation of CCDS systems for early detection of adult sepsis inpatients. METHODS The protocol for this scoping review has been previously published. Ten electronic databases (MEDLINE, Embase, CINAHL, The Cochrane database, LILACS, Scopus, Web of Science, OpenGrey, clinicaltrials.gov, and PQDT) were comprehensively searched to identify relevant studies. Title, abstract, and full-text screening were performed by two independent reviewers using predefined eligibility criteria. Data charting was performed by one reviewer with a second reviewer double checking a random sample of studies. Any disagreements were discussed with input from a third reviewer. In this review we present the results for adult inpatients, including studies that do not specify patient age. RESULTS A search of the electronic databases retrieved 12139 studies following duplicate removal. We identified 124 studies for inclusion after title, abstract, full-text screening, and hand-searching were complete. Nearly all studies (n=121, 97.6%) were published after 2009. Half the studies were journal articles (n=65), and the remainder were conference abstracts and theses (n=54 and 5 respectively). Most studies used a single cohort (n=54; 43.5%) or before-after (n=42; 33.9%) approach. Of all 124 included studies, patient outcomes were the most frequently reported outcomes (n=107; 86.3%), followed by sepsis treatment and management (n=75; 60.5%), CCDS usability (n=14; 11.3%), and cost outcomes (n=9; 7.3%). For sepsis identification, the systemic inflammatory response syndrome (SIRS) criteria were the most commonly used, either alone (n=50; 40.3%), combined with organ dysfunction (n=28; 22.6%) or combined with other criteria (n=23; 18.5%). Over half of the CCDS systems (n=68; 54.8%) were implemented alongside other sepsis-related interventions. CONCLUSIONS The current body of literature investigating the implementation of CCDS systems for the early detection of adult sepsis inpatients is extremely diverse. There is substantial variability in study design, CCDS criteria and characteristics, and outcomes measured across the identified literature. Future research on CCDS system usability, cost, and impact on sepsis morbidity is needed. INTERNATIONAL REGISTERED REPORT RR2-10.2196/24899

Organizational Factors Influencing the Use of Clinical Decision Support for Improving Cancer Screening Within Community Health Centers

2016 ◽  
pp. 118-148 ◽  
Author(s):  
Timothy Jay Carney ◽  
Michael Weaver ◽  
Anna M. McDaniel ◽  
Josette Jones ◽  
David A. Haggstrom
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Decision Support ◽  
Cancer Screening ◽  
Community Health ◽  
Clinical Decision Support ◽  
Community Health Centers ◽  
Clinical Decision ◽  
Health Centers ◽  
Practice Setting

Adoption of clinical decision support (CDS) systems leads to improved clinical performance through improved clinician decision making, adherence to evidence-based guidelines, medical error reduction, and more efficient information transfer and to reduction in health care disparities in under-resourced settings. However, little information on CDS use in the community health care (CHC) setting exists. This study examines if organizational, provider, or patient level factors can successfully predict the level of CDS use in the CHC setting with regard to breast, cervical, and colorectal cancer screening. This study relied upon 37 summary measures obtained from the 2005 Cancer Health Disparities Collaborative (HDCC) national survey of 44 randomly selected community health centers. A multi-level framework was designed that employed an all-subsets linear regression to discover relationships between organizational/practice setting, provider, and patient characteristics and the outcome variable, a composite measure of community health center CDS intensity-of-use. Several organizational and provider level factors from our conceptual model were identified to be positively associated with CDS level of use in community health centers. The level of CDS use (e.g., computerized reminders, provider prompts at point-of-care) in support of breast, cervical, and colorectal cancer screening rate improvement in vulnerable populations is determined by both organizational/practice setting and provider factors. Such insights can better facilitate the increased uptake of CDS in CHCs that allows for improved patient tracking, disease management, and early detection in cancer prevention and control within vulnerable populations.

Advanced Issues of Health Informatics and Clinical Decision Support System in Global Health Care

2018 ◽  
pp. 153-170 ◽  
Author(s):  
Kijpokin Kasemsap
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Global Health ◽  
Decision Support System ◽  
Clinical Decision Support ◽  
Support System ◽  
Health Informatics ◽  
Clinical Decision Support System ◽  
Clinical Decision ◽  
Global Health Care

This chapter indicates the advanced issues of health informatics; the advanced issues of Clinical Decision Support System (CDSS); CDSS and Computerized Physician Order Entry (CPOE); the false positive alerts in CDSS; and CDSS and biomedical engineering. Health informatics and CDSS are the advanced health care technologies with the support of many technological fields. Health informatics and CDSS apply various computerized devices to provide enhanced health-related outcomes in terms of problem solving, analytical thinking, and decision making. Health informatics and CDSS help clinicians and health care providers to make complex information useful in supporting clinical decisions, thus delivering the best standard of care for each patient. The chapter argues that utilizing health informatics and CDSS has the potential to increase health outcomes and reach strategic goals in global health care.

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 Designing and using incentives to support recruitment and retention in clinical trials: a scoping review and a checklist for design

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Beth Parkinson ◽  
Rachel Meacock ◽  
Matt Sutton ◽  
Eleonora Fichera ◽  
Nicola Mills ◽  
...  
Keyword(s):  
Scoping Review ◽  
Pay For Performance ◽  
Evidence Base ◽  
Unintended Consequences ◽  
Current Evidence ◽  
Incentive System ◽  
Design Issues ◽  
Recruitment And Retention ◽  
Design Choice ◽  
Current Evidence Base

Abstract Background Recruitment and retention of participants are both critical for the success of trials, yet both remain significant problems. The use of incentives to target participants and trial staff has been proposed as one solution. The effects of incentives are complex and depend upon how they are designed, but these complexities are often overlooked. In this paper, we used a scoping review to ‘map’ the literature, with two aims: to develop a checklist on the design and use of incentives to support recruitment and retention in trials; and to identify key research topics for the future. Methods The scoping review drew on the existing economic theory of incentives and a structured review of the literature on the use of incentives in three healthcare settings: trials, pay for performance, and health behaviour change. We identified the design issues that need to be considered when introducing an incentive scheme to improve recruitment and retention in trials. We then reviewed both the theoretical and empirical evidence relating to each of these design issues. We synthesised the findings into a checklist to guide the design of interventions using incentives. Results The issues to consider when designing an incentive system were summarised into an eight-question checklist. The checklist covers: the current incentives and barriers operating in the system; who the incentive should be directed towards; what the incentive should be linked to; the form of incentive; the incentive size; the structure of the incentive system; the timing and frequency of incentive payouts; and the potential unintended consequences. We concluded the section on each design aspect by highlighting the gaps in the current evidence base. Conclusions Our findings highlight how complex the design of incentive systems can be, and how crucial each design choice is to overall effectiveness. The most appropriate design choice will differ according to context, and we have aimed to provide context-specific advice. Whilst all design issues warrant further research, evidence is most needed on incentives directed at recruiters, optimal incentive size, and testing of different incentive structures, particularly exploring repeat arrangements with recruiters.

scholarly journals Comparison of Computer-based Clinical Decision Support Systems and Content for Diabetes Mellitus

2011 ◽  
Vol 02 (03) ◽  
pp. 284-303 ◽  
Author(s):  
A. Wright ◽  
M. Burton ◽  
G. Fraser ◽  
M. Krall ◽  
S. Maviglia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Decision Making ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Diabetes Care ◽  
Clinical Decision ◽  
The United States ◽  
Computer Based

SummaryBackground: Computer-based clinical decision support (CDS) systems have been shown to improve quality of care and workflow efficiency, and health care reform legislation relies on electronic health records and CDS systems to improve the cost and quality of health care in the United States; however, the heterogeneity of CDS content and infrastructure of CDS systems across sites is not well known.Objective: We aimed to determine the scope of CDS content in diabetes care at six sites, assess the capabilities of CDS in use at these sites, characterize the scope of CDS infrastructure at these sites, and determine how the sites use CDS beyond individual patient care in order to identify characteristics of CDS systems and content that have been successfully implemented in diabetes care.Methods: We compared CDS systems in six collaborating sites of the Clinical Decision Support Consortium. We gathered CDS content on care for patients with diabetes mellitus and surveyed institutions on characteristics of their site, the infrastructure of CDS at these sites, and the capabilities of CDS at these sites.Results: The approach to CDS and the characteristics of CDS content varied among sites. Some commonalities included providing customizability by role or user, applying sophisticated exclusion criteria, and using CDS automatically at the time of decision-making. Many messages were actionable recommendations. Most sites had monitoring rules (e.g. assessing hemoglobin A1c), but few had rules to diagnose diabetes or suggest specific treatments. All sites had numerous prevention rules including reminders for providing eye examinations, influenza vaccines, lipid screenings, nephropathy screenings, and pneumococcal vaccines.Conclusion: Computer-based CDS systems vary widely across sites in content and scope, but both institution-created and purchased systems had many similar features and functionality, such as integration of alerts and reminders into the decision-making workflow of the provider and providing messages that are actionable recommendations.

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