BEST PRACTICES FOR INTEGRATING CLINICAL DECISION SUPPORT INTO CLINICAL WORKFLOW Thus far, the return on investment for the adoption of health information technology has been disappointing. There is a clear need for the development of implementation strategies to improve the value of health IT for medical practices. In response to Special Emphasis Notice (NOT-HS-13-006), we propose to pursue the following aims: 1) to assess the practice-level factors that are associated with successful implementation of clinical decision support and 2) to assess the comparative effectiveness of use of a clinical decision support framework with and without practice coaching. To achieve the first aim, we will assess trends in the use of clinical decision support (CDS) targeting cardiovascular disease prevention and asthma management, trends in achieving the clinical process and treatment goals for the target conditions, and determine the practice-level characteristics that are associated with higher rates of achievement for the CDS use, clinical process, and clinical treatment goals. This assessment will be conducted with a national network of Federally Qualified Health Centers as they implement the use of a structured clinical decision support implementation framework, the CDS Five Rights approach, to promote better integration of clinical decision support into clinical workflow.
Aim 2 will be achieved by conducting a site-randomized trial of federally-qualified health centers comparing use of the CDS Five Rights Approach alone or use of the CDS Five Rights Approach with practice coaching on measures of CDS use, CDS integration, and clinical outcomes. To assess whether the intensity of support needed varies based on the health center's quality-related characteristics, randomization of the participating sites will be stratified by the health center's baseline quality characteristics (high, medium, or low levels of quality improvement infrastructure and innovativeness). The study implementation and evaluation plans draw on the Diffusion of Innovations and RE-AIM frameworks, respectively. The results of this study will inform key policy-relevant questions: What strategies will best facilitate the effective implementation of Stage 3 meaningful use objectives? Will these strategies be effective in practices that serve large numbers of patients from socio- demographic groups that have had the worst health outcomes (e.g. the poor, the uninsured, and racial and ethnic minorities)? And finally, how can Stage 3 meaningful use objectives be best integrated into clinical work flow and how will clinical work flow need to change to best support the achievement of meaningful use?

Public Health Relevance

BEST PRACTICES FOR INTEGRATING CLINICAL DECISION SUPPORT INTO CLINICAL WORKFLOW There is a large gap between the quality of care we should be able to achieve within the U.S. health care system and the quality of care that we do achieve. Improving the use of health information technology to make sure that the right information is available to the right patient and the right people on their care team at the right time is one step towards realizing the goal of high quality care for every person every time. The lessons learned from this research will help to develop health information technology systems (i.e. electronic health record systems or personal health record systems) that better help doctors, nurses, patients, and other members of the health care team to provide high quality care.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Care Technology and Decision Science (HTDS)
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Roper, Rebecca
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Northwestern University at Chicago
Internal Medicine/Medicine
Schools of Medicine
United States
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