Search all AHRQ sites
Menu
SHARE:
AHRQ Research Studies
Sign up: 
AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 186 Research Studies DisplayedJones EK, Ninkovic I, Bahr M
A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures.
This study’s objective to investigate if a traumatic rib fracture clinical decision support system (CDSS) reduced hospital length of stay (LOS), 90-day and 1-year mortality, unplanned ICU transfer, and the need for mechanical ventilation. The CDSS included an admission evidence-based (EB) order set and a pain-inspiratory-cough (PIC) score early warning system (EWS). The CDSS was implemented at 9 US trauma centers, with 3,279 patients meeting inclusion criteria. Hospital LOS pre vs post-intervention was unchanged but unplanned transfer to the ICU was reduced, as was 1-year mortality. Provider utilization was associated with significantly reduced LOS. The EWS triggered on 34.4% of patients; however, it was not associated with a significant reduction in hospital LOS.
AHRQ-funded; HS026379.
Citation: Jones EK, Ninkovic I, Bahr M .
A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures.
J Trauma Acute Care Surg 2023 Aug 1; 95(2):161-71. doi: 10.1097/ta.0000000000003866..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Evidence-Based Practice, Injuries and Wounds, Trauma
Rolfzen ML, Wick A, Mascha EJ
Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): a cluster randomized multiple crossover trial.
This study tested the hypothesis that a decision-support tool embedded in electronic health records (EHRs) leads clinicians to prescribe fewer opioids at discharge after inpatient surgery. Over 21,000 surgical inpatient discharges in a cluster randomized multiple crossover trial in four Colorado hospitals were included. The results indicated that within the context of vigorous opioid education and awareness efforts a decision-support tool incorporated into EHRs did not reduce discharge opioid prescribing for postoperative patients. The authors concluded that opioid prescribing alerts might be valuable in other contexts.
AHRQ-funded; HS027795.
Citation: Rolfzen ML, Wick A, Mascha EJ .
Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): a cluster randomized multiple crossover trial.
Anesthesiology 2023 Aug 1; 139(2):186-96. doi: 10.1097/aln.0000000000004607..
Keywords: Opioids, Medication, Surgery, Inpatient Care, Clinical Decision Support (CDS), Health Information Technology (HIT)
Roberts MM, Marino M, Wells R
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
The objective of this cross-sectional study was to evaluate the association between population-based clinical decision support (CDS) tools and racial and sex disparities in the aspirin use, blood pressure control, cholesterol management, and smoking cessation (ABCS) care quality metrics among smaller primary care practices. Researchers used practice-level data from the EvidenceNOW initiative, from practices that submitted both survey data and electronic health record (EHR)-derived ABCS data stratified by race and sex. Their findings suggested that practices using CDS tools had small disparities but were not statistically significant; however, CDS tools were not associated with reductions in disparities. They concluded that more research was needed on effective practice-level interventions to mitigate disparities.
AHRQ-funded; HS023940.
Citation: Roberts MM, Marino M, Wells R .
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
JAMA Netw Open 2023 Aug; 6(8):e2326905. doi: 10.1001/jamanetworkopen.2023.26905..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Cardiovascular Conditions, Tobacco Use, Tobacco Use: Smoking Cessation, Primary Care, Evidence-Based Practice, Prevention
Blecker S, Gannon M, De Leon S
Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial.
This paper describes a protocol for a study that will be conducted to compare the effect of hypertension-focused clinical decision support (CDS) plus practice facilitation on blood pressure (BP) control, as compared to CDS alone. The investigators will conduct a cluster randomized control trial that will include initial training on the CDS and a review of current guidelines along with follow-up for coaching and integration support. They will randomize 46 small primary care practices in New York City who use the same electronic health record vendor to intervention or control. They will also assess implementation of CDS in all practices and practice facilitation in the intervention group.
AHRQ-funded; HS027120.
Citation: Blecker S, Gannon M, De Leon S .
Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial.
Contemp Clin Trials 2023 Jun; 129:107177. doi: 10.1016/j.cct.2023.107177..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Blood Pressure, Cardiovascular Conditions
Lee AH, McEvoy DS, Stump T
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
This study analyzed the influence of clinical decision support (CDS) to prevent delays in second doses of broad-spectrum antibiotics in the emergency department (ED). The authors allocated adult patients who received cefepime or piperacillin/tazobactam in 9 EDs within an integrated health care system to an electronic alert that reminded ED clinicians to reorder antibiotics at the appropriate interval vs usual care. Primary outcome was a median delay in antibiotic administration, and secondary outcomes were rates of intensive care unit (ICU) admission, hospital mortality, and hospital length of stay. A total of 1,113 ED patients treated with cefepime or piperacillin/tazobactam were enrolled in the study, of whom 420 remained under ED care when their second dose was due. The electronic alert system was associated with reduced antibiotic delays, but there were no differences in ICU transfers, inpatient mortality, or hospital length of stay.
AHRQ-funded; HS027170.
Citation: Lee AH, McEvoy DS, Stump T .
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
Ann Emerg Med 2023 Apr;81(4):485-91. doi: 10.1016/j.annemergmed.2022.10.022.
Keywords: Antibiotics, Medication, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT)
Ingraham NE, Jones EK, King S
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
This scoping review explored surgical literature to determine frequency and rigor of clinical decision support (CDS) equity assessments and offer recommendations to improve CDS equity by appending existing frameworks. The authors performed a scoping review of PubMed and Google Scholar and identified 1,415 citations with 229 abstracts meeting criteria for review. A total of 84 papers underwent full review after 145 were excluded if they did not assess outcomes of an electronic CDS tool or have a surgical use case. Only 6% of surgical CDS systems reported equity analyses, suggesting that current methods for optimizing equity in surgical CDS are inadequate. The authors proposed revising the RE-AIM framework to include an Equity element (RE2-AIM) specifying that CDS foundational analyses and algorithms are performed or trained on balanced datasets with sociodemographic characteristics that accurately represent the CDS target population and are assessed by sensitivity analyses focused on vulnerable subpopulations.
AHRQ-funded; HS026379; HS024532.
Citation: Ingraham NE, Jones EK, King S .
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
Ann Surg 2023 Mar; 277(3):359-64. doi: 10.1097/sla.0000000000005661..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Disparities, Surgery
Shear K, Rice H, Garabedian PM
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
The purpose of this study was to conduct usability testing of the ASPIRE fall risk management tool for use in divergent primary care clinics. Participants recruited from two sites with different electronic health records and clinical organizations used ASPIRE across two clinical scenarios; they rated ASPIRE usability as above average, based on usability benchmarks. Time spent on tasks decreased significantly between the first and second scenarios, indicating ease of learnability. The authors conclude that ASPIRE could be integrated into diverse organizations, since it allows a tailored implementation without the need to build a new system for each organization. ASPIRE is therefore well positioned to impact the challenge of falls at scale.
AHRQ-funded; HS027557.
Citation: Shear K, Rice H, Garabedian PM .
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
Appl Clin Inform 2023 Mar;14(2):212-26. doi: 10.1055/a-2006-4936.
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Falls, Primary Care, Risk, Prevention
Djulbegovic B, Hozo I, Lizarraga D
Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants.
The objective of this study was to assess if delivery of anticoagulant prophylaxis according to an algorithm improved clinical outcomes in patients hospitalized with COVID-19 in comparison with anticoagulant treatment given at individual practitioners' discretion. Findings indicated that the algorithm did not reduce death, venous thromboembolism, nor major bleeding, but helped avoid longer hospital stay and admission to an intensive-care unit.
AHRQ-funded; HS024917.
Citation: Djulbegovic B, Hozo I, Lizarraga D .
Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants.
J Eval Clin Pract 2023 Feb; 29(1):3-12. doi: 10.1111/jep.13780..
Keywords: COVID-19, Clinical Decision Support (CDS), Blood Thinners, Medication, Evidence-Based Practice, Health Information Technology (HIT)
Gephart SM, Tolentino DA, Quinn MC
Neonatal intensive care workflow analysis informing NEC-Zero clinical decision support design.
The aim of this qualitative descriptive study was to explore the current clinical workflow and sociotechnical processes of clinicians for necrotizing enterocolitis risk awareness, timely discovery of symptoms, and treatment to guide decision support design. The researchers conducted 11 focus groups in two neonatal ICUs. The study found that workflow processes were different for nurses (who observe the signs of necrotizing enterocolitis and inform providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide what actions to take). The researchers reported that clinicians wanted a necrotizing enterocolitis-relevant dashboard with: 1) nutrition tracking and recognition of necrotizing enterocolitis; 2) features to support decision-making; 3) breast milk tracking and feeding clinical decision support; 4) tools for necrotizing enterocolitis surveillance and quality reporting; and 5) general electronic health records improvements to enhance user experience.
AHRQ-funded; HS022908.
Citation: Gephart SM, Tolentino DA, Quinn MC .
Neonatal intensive care workflow analysis informing NEC-Zero clinical decision support design.
Comput Inform Nurs 2023 Feb; 41(2):94-101. doi: 10.1097/cin.0000000000000929..
Keywords: Newborns/Infants, Clinical Decision Support (CDS), Intensive Care Unit (ICU), Workflow, Health Information Technology (HIT)
Rizk S, Kaelin VC, Sim JGC
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
The study’s aim was to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs. A mixed-methods study was conducted with EI families (n = 6), service coordinators (n = 9), and program leadership (n = 7). Semi-structured interviews and focus groups were conducted and used to share quantitative trial results. All three stakeholder groups identified thematic supports and barriers across multiple constructs within each of four Consolidated Framework for Implementation Research (CFIR) domains: (1) Six themes for "intervention characteristics," (2) Six themes for "process," (3) Three themes for "inner setting," and (4) Four themes for "outer setting." Priorities from stakeholders included prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes ("process"); and fostering a positive implementation climate ("inner setting"). Improving EI access (“outer setting”) using YC-PEM e-PRO results was also articulated by service coordinators and program leadership.
AHRQ-funded; HS027583.
Citation: Rizk S, Kaelin VC, Sim JGC .
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
Appl Clin Inform 2023 Jan; 14(1):91-107. doi: 10.1055/s-0042-1760631..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Children/Adolescents, Evidence-Based Practice, Patient-Centered Outcomes Research, Implementation
Gomez Lumbreras A, Reese TJ, Del Fiol G
Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction.
This study evaluated a tool called DDInteract that was developed to enhance and support shared decision-making (SDM) between patients and physicians when both warfarin and NSAIDs are used concurrently. The study used case vignettes with physicians and patients on warfarin to conduct simulated virtual clinical encounters where they discussed the use of taking ibuprofen and warfarin concurrently and determined an appropriate therapeutic plan based on the patient’s individualized risk. Participants completed a postsession interview and SDM process survey, including the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), tool usability and workload National Aeronautics and Space Administration (NASA) Task Load Index, Unified Theory of Acceptance and Use of Technology (UTAUT), Perceived Behavioral Control (PBC) scale, System Usability Scale (SUS), and Decision Conflict Scale (DCS). A total of 12 physician-patient dyads were used, with over 91% of the patients over 50 and 75% had been taking warfarin for over 2 years. Most participants rated DDInteract higher than usual care (UC) and would be willing to use the tool for an interaction involving warfarin and NSAIDs.
AHRQ-funded; HS027099.
Citation: Gomez Lumbreras A, Reese TJ, Del Fiol G .
Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction.
JMIR Form Res 2022 Oct 19;6(10):e40018. doi: 10.2196/40018..
Keywords: Decision Making, Medication, Blood Thinners, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication: Safety, Patient Safety
Weiner SJ, Schwartz A, Weaver F
Effect of electronic health record clinical decision support on contextualization of care: a randomized clinical trial.
Researchers sought to determine whether contextualized clinical decision support (CDS) tools in the electronic health record (EHR) improve clinician contextual probing, attention to contextual factors in care planning, and the presentation of contextual red flags. In this randomized clinical trial, they found that contextualized CDS did not improve patients' outcomes but did increase contextualization of their care, suggesting that use of this technology could ultimately help to improve outcomes.
AHRQ-funded; HS025374.
Citation: Weiner SJ, Schwartz A, Weaver F .
Effect of electronic health record clinical decision support on contextualization of care: a randomized clinical trial.
JAMA Netw Open 2022 Oct;5(10):e2238231. doi: 10.1001/jamanetworkopen.2022.38231..
Keywords: Electronic Health Records (EHRs), Clinical Decision Support (CDS), Health Information Technology (HIT), Decision Making
Dorr DA, Richardson JE, Bobo M
Provider perspectives on patient- and provider-facing high blood pressure clinical decision support.
This study tried to partly address the challenge of developing a patient-facing clinician decision support (CDS) for persistent high blood pressure (HBP). The authors sought to understand provider variations and rationales related to HBP guideline recommendations and perceptions regarding patient role and use of digital tools. They implemented a pilot and final survey for hypertension experts and primary care physicians. Five clinical cases were presented that queried clinicians' attitudes related to actions; variations; prioritization; patient input; importance; and barriers for HBP diagnosis, monitoring, and treatment. Fifteen hypertension experts and 14 providers took the pilot and final versions of the survey. The majority (over 80%) of providers felt the recommendations were important yet found them difficult to follow-up to 90% of the time. Provider perceptions of relative amounts of patient input and patient work for effective HBP management ranged from 22 to 100%. Reasons for variation provided included adverse effects of treatment, patient comorbidities, shared decision-making, and health care cost and access issues. Respondents were generally positive toward patient use of electronic CDS applications but worried about access to health care, nuance of recommendations, and patient understanding of the tools.
AHRQ-funded; HS26849.
Citation: Dorr DA, Richardson JE, Bobo M .
Provider perspectives on patient- and provider-facing high blood pressure clinical decision support.
Appl Clin Inform 2022 Oct;13(5):1131-40. doi: 10.1055/a-1926-0199..
Keywords: Blood Pressure, Clinical Decision Support (CDS), Decision Making, Provider: Physician
Dutta S, McEvoy DS, Rubins DM
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
This paper discusses the outcomes of using a clinical decision support (CDS) tool that was implemented in emergency departments (EDs) for sepsis patients to remind healthcare staff to take blood cultures before administration of intravenous (IV) antibiotics. The study compared timely blood culture collection outcomes prior to IV antibiotics for 54,538 adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. The baseline phase found that 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. The CDS improved blood culture collection rates without increasing overutilization.
AHRQ-funded; HS02717.
Citation: Dutta S, McEvoy DS, Rubins DM .
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
J Am Med Inform Assoc 2022 Sep 12;29(10):1705-14. doi: 10.1093/jamia/ocac115..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Antibiotics, Emergency Department, Medication, Sepsis
Gallo T, Heise CW, Woosley RL
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
The purpose of this study was to create an advanced torsades de pointes (TdP) clinical decision support (CDS) advisory that provides relevant, patient-specific information, including 1-click management options, and to evaluate clinician satisfaction with the CDS. The researchers implemented the advanced TdP CDS across a health system comprising 29 hospitals. A brief electronic survey was developed to collect clinician feedback on the advisory and was emailed to 442 clinicians who received the advisory. Feedback was generally positive across the 38 responding providers, with 79% of respondents reporting that the advisory assisted with their care for their patients and 87% responding that the alerts clearly specified alternative actions. The researchers concluded that providers who receive an advanced TdP risk CDS alert generally view the alert favorably.
AHRQ-funded; HS026662.
Citation: Gallo T, Heise CW, Woosley RL .
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
J Patient Saf 2022 Sep 1;18(6):e1010-e13. doi: 10.1097/pts.0000000000000996..
Keywords: Clinical Decision Support (CDS), Decision Making, Risk, Provider: Clinician, Heart Disease and Health, Cardiovascular Conditions
Kagarmanova A, Sparkman H, Laiteerapong N
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
This article describes a protocol for an upcoming study on the planned implementation and evaluation of I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO®) to improve care for older adults with chronic pain, opioid use, and opioid use disorder (OUD). The study will be implemented in 35 clinical sites across the metropolitan Chicago area for patients aged ≥ 65 with chronic pain, opioid use, or OUD who receive primary care at one of the clinics. I-COPE includes the integration of patient-reported data on symptoms and preferences, clinical decision support tools and shared decision making into routine primary care. Primary care providers will be trained on the tools through web-based videos and an optional Project ECHO® course, entitled "Pain Management and OUD in Older Adults." A framework called RE-AIM will be used to assess the I-COPE implementation. Outcomes considered effective include an increased variety of recommended pain treatments, decreased prescriptions of higher-risk pain treatments, and decreased patient pain scores. Outcomes will be evaluated at 6 and 12 months after implementation, and PCPs participating in Project ECHO® will be evaluated on changes in knowledge, attitudes, and self-efficacy using pre- and post-course surveys.
AHRQ-funded; HS027910.
Citation: Kagarmanova A, Sparkman H, Laiteerapong N .
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
Trials 2022 Jul 27;23(1):602. doi: 10.1186/s13063-022-06537-w..
Keywords: Elderly, Pain, Chronic Conditions, Opioids, Medication, Substance Abuse, Behavioral Health, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT)
Hinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
AHRQ-funded; HS026640.
Citation: Hinson JS, Klein E, Smith A .
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Decision Making
Salloum RG, Bilello L, Bian J
Study protocol for a type III hybrid effectiveness-implementation trial to evaluate scaling interoperable clinical decision support for patient-centered chronic pain management in primary care.
The objective of this 3-year project is to study the adaptation and implementation of an existing interoperable clinical decision support (CDS) tool for pain treatment shared decision making, with tailored implementation support, in new clinical settings in the OneFlorida Clinical Research Consortium. The evaluation will be organized by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, with an adaptation and tailoring of PainManager, an open source interoperable CDS tool. It is anticipated that this evaluation will establish the feasibility and obtain preliminary data in preparation for a multi-site pragmatic trial targeting the effectiveness of PainManager and tailored implementation support on shared decision making and patient-reported pain and physical function.
AHRQ-funded; R18 HS028584.
Citation: Salloum RG, Bilello L, Bian J .
Study protocol for a type III hybrid effectiveness-implementation trial to evaluate scaling interoperable clinical decision support for patient-centered chronic pain management in primary care.
Implement Sci 2022 Jul 15;17(1):44. doi: 10.1186/s13012-022-01217-4..
Keywords: Clinical Decision Support (CDS), Pain, Chronic Conditions, Primary Care, Health Information Technology (HIT), Patient-Centered Outcomes Research, Patient-Centered Healthcare
Nanji KC, Garabedian PM, Langlieb ME
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
The purpose of this study was assess the usability of a newly developed, comprehensive, medication-related operating room clinical decision support (CDS) software and compare it with the standard electronic health record (EHR) medication workflow. Forty participants were randomized to a CDS group (n=20) or a control group (n=20) and asked to complete 7 simulation tasks. The study found that in a simulation setting the new CDS software improved efficiency and quality of care and reduced task time, excelling over the current EHR workflow.
AHRQ-funded; HS024764.
Citation: Nanji KC, Garabedian PM, Langlieb ME .
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
J Am Med Inform Assoc 2022 Jul 12;29(8):1416-24. doi: 10.1093/jamia/ocac035..
Keywords: Medication, Clinical Decision Support (CDS), Health Information Technology (HIT), Surgery, Decision Making
Reese T, Wright A, Liu S
Improving the specificity of drug-drug interaction alerts: can it be done?
A lack of accuracy and specificity of medication alerts have an impact on alert fatigue, high rates of override, and harm to the patient. The drugs that activate alerts are frequently grouped inconsistently into value sets, and alerts for drug-drug interactions (DDI) often do not account for the factors that could decrease risk. The purpose of this proof-of-concept study was to identify and bring attention to the inconsistency of drug value sets for activating alerts, as well as provide a method of classifying factors that can be utilized to alter the risk of harm from a DDI. The researchers included 15 well-known DDIs, and utilized 3 drug interaction references to isolate 2 drug value sets as well as order- and patient-related factors for each DDI. The study reported 30 value sets, with 56% of value sets (17) having nonsignificant agreement, with average moderate agreement among the remaining 13 value sets. Thirty-three factors were identified that could decrease risk in 93% (14) of the 15 DDIs. The researchers concluded that the study shows the value of improving the consistency of DDI-alerting drug value sets, and ways in which alert usefulness and specificity can be improved.
AHRQ-funded; HS025984; HS023826.
Citation: Reese T, Wright A, Liu S .
Improving the specificity of drug-drug interaction alerts: can it be done?
Am J Health Syst Pharm 2022 Jun 23;79(13):1086-95. doi: 10.1093/ajhp/zxac045..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Clinical Decision Support (CDS), Health Information Technology (HIT)
Dullabh P, Sandberg SF, Heaney-Huls K
Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.
This AHRQ-authored horizon scan identified challenges and opportunities for advancing patient-centered clinical decision support (PC CDS) and future directions for PC CDS. The authors engaged a technical expert panel, conducted a scoping literature review, and interviewed key informants. They quantitatively analyzed literature and interview transcripts and mapped the findings to the 4 phases translating evidence into PC CDS interventions (Prioritizing, Authoring, Implementing, and Measuring) and to external factors. Twelve challenges were identified for PC CDS development with lack of patient input identified as a critical challenge. Lack of patient-centered terminology standards was viewed as a challenge in authoring PC CDS. They also found a dearth of CDS studies that measured clinical outcomes, creating significant gaps in the understanding of PC CDS’ impact.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dullabh P, Sandberg SF, Heaney-Huls K .
Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.
J Am Med Inform Assoc 2022 Jun 14;29(7):1233-43. doi: 10.1093/jamia/ocac059.
.
.
Keywords: Clinical Decision Support (CDS), Patient-Centered Healthcare, Health Information Technology (HIT), Decision Making, Patient-Centered Outcomes Research, Evidence-Based Practice
Gallo T, Heise CW, Woosley RL
Clinician responses to a clinical decision support advisory for high risk of Torsades de pointes.
The purpose of this study was to assess provider actions taken in response to a Clinical decision support (CDS) advisory for Torsade de pointes (TdP) that uses a modified Tisdale QT risk score and presents single click management options. The researchers implemented an inpatient TdP risk advisory across a large, 30 hospital health care system. The CDS advisory was programmed to appear when prescribers attempted to order medications with a known risk of TdP in a patient. The CDS advisory displayed patient-specific information and offered related management options including canceling the requested medication and ordering relevant protocols. The study found that 7794 TdP risk advisories were issued during an 8-month period. The most frequent advisory trigger was antibiotics (33.1%.) The most frequent action taken as a result of the advisory was ordering an ECG (20.3%). Incoming medication orders were canceled in 10.2% of the advisories. The researchers concluded that a single-click, modified Tisdale QT risk score-based CDS resulted in a high action/response rate.
AHRQ-funded; HS026662.
Citation: Gallo T, Heise CW, Woosley RL .
Clinician responses to a clinical decision support advisory for high risk of Torsades de pointes.
J Am Heart Assoc 2022 Jun 7;11(11):e024338. doi: 10.1161/jaha.122.024338..
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions
Villa Zapata L, Subbian V, Boyce RD
Overriding drug-drug interaction alerts in clinical decision support systems: a scoping review.
The authors reviewed published data on the rate of Drug-Drug Interactions (DDI) alert overrides and medications involved in the overrides. Among 34 eligible studies, they found that the override rate of DDI alerts ranged from 55% to 98%, with more than half of the studies reporting the most common drug pairs or medications involved in acceptance or overriding of alerts. They recommended decision support systems that take user, drug, and institutional factors into consideration, as well as actionable metrics to better characterize harm associated with overrides.
AHRQ-funded; HS025984; HS023826.
Citation: Villa Zapata L, Subbian V, Boyce RD .
Overriding drug-drug interaction alerts in clinical decision support systems: a scoping review.
Stud Health Technol Inform 2022 Jun 6;290:380-84. doi: 10.3233/shti220101..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Medication
Dullabh P, Heaney-Huls K, Hovey L
The technology landscape of patient-centered clinical decision support - where are we and what is needed?
This paper explores the technology landscape for patient-centered clinical decision support (PC CDS) and what has come out of Patient Centered Outcomes Research (PCOR) and health care delivery system transformation efforts. The authors explore what is needed to make it more shareable, standards-based, and publicly available with the goal of improving patient care and clinical outcomes. Three sources of information were used: (1) a 22-member technical expert panel; (2) a literature review of peer-reviewed and grey literature; and (3) key informant interviews with PC CDS stakeholders. Ten salient technical considerations that span all phases of PC CDS development were identified. Although significant progress has been made, challenges remain.
AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls K, Hovey L .
The technology landscape of patient-centered clinical decision support - where are we and what is needed?
Stud Health Technol Inform 2022 Jun 6;290:350-53. doi: 10.3233/shti220094..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Patient-Centered Outcomes Research, Decision Making
Dullabh P, Heaney-Huls K, Lobach DF
The technical landscape for patient-centered CDS: progress, gaps, and challenges.
The purpose of this study was to evaluate the technical landscape for patient-centered clinical decision support (PC CDS) methods to assess the gaps in making PC CDS more standard-based, publicly available, and with greater shareability. The researchers utilized qualitative data from a literature review, a panel of technical experts, and interviews with 18 CDS stakeholders to identify 7 technical considerations that span 5 phases of the development of PC CDS. The authors concluded that while there has been progress in the technical landscape, the field of CDS must focus on improving a number of CDS methods and processes, including standards for translating clinical guidelines into patient-centered clinical decision support, procedures to collect, standardize, and incorporate health data generated by patients, and other CDS processes.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls K, Lobach DF .
The technical landscape for patient-centered CDS: progress, gaps, and challenges.
J Am Med Inform Assoc 2022 May 11;29(6):1101-05. doi: 10.1093/jamia/ocac029..
Keywords: Clinical Decision Support (CDS), Decision Making, Patient-Centered Healthcare, Health Information Technology (HIT)
