Dissemination and Implementation of QT Risk Clinical Decision Support. Clinical decision support (CDS) for electronic health records (EHR) and prescribing systems has been promoted to improve patient outcomes. Torsades de Pointes (TdP), is a life-threatening arrhythmia associated with the prolongation of the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG). Specifically, TdP is polymorphic ventricular tachycardia preceded by QTc prolongation and usually manifesting as short bursts of ventricular contractions between 160 and 250 beats per minute that occur in rapid succession. A QTc Risk Score (QTc-RS) CDS can calculate the risk for QTc prolongation and assist doctors and other healthcare providers in mitigating the risk of TdP. The central hypothesis of this project is that the dissemination and implementation of a CDS algorithm incorporating the QTc-RS will result in fewer instances of drug-induced prolonged QTc interval, reduce the number of excessive lengths of stay and potentially lead to fewer sudden cardiac deaths. This proposal describes a health information technology research project aimed at the dissemination and implementation of the QTc-RS in a non-profit network of 28 facilities located in five western states that serve rural and urban communities. These facilities are located in regions of the Rocky Mountain west that have a high proportion of underserved American Indian, Latino, and economically disadvantaged populations. We will accomplish our objectives by pursuing the following aims:
Aim 1 : Adapt, implement, and disseminate a QTc-RS CDS in rural and urban facilities across varying acuity levels within inpatient care facilities;
Aim 2 : Develop and deliver an educational program on QTc interval prolongation, Torsades de Pointes, and the QTc interval prolongation risk score CDS to health professionals practicing in in-patient environments;
Aim 3 : Evaluate the effectiveness of a QTc-RS clinical decision support with respect to process changes within facilities, patient focused clinical outcomes, and end-user satisfaction. The proposed project will reduce the risk of QTc prolongation among vulnerable patients while simultaneously ensuring that providers are not overburdened with irrelevant warnings. We recognize that successful CDS implementation requires education and ongoing support. The educational aspects of this project will provide context and rationale for the risk score using a multi-faceted program that will ensure that dissemination and implementation is long-lasting. This project will greatly improve patient safety and improve health care processes by incorporating real-time contextual factors into evidence-based and validated alert algorithms that meet the five ?rights? of meaningful CDS. In summary, the project supports the mission of the Agency for Healthcare Research and Quality by improving the quality of healthcare and enhancing patient safety in rural, underserved, and minority populations.

Public Health Relevance

Torsades de Pointes (TdP), is a life-threatening arrhythmia associated with the prolongation of the heart rate- corrected QT (QTc) interval on the electrocardiogram (ECG), and if unrecognized and untreated, patients can experience multiple TdP episodes, leading to ventricular fibrillation and sudden cardiac death. To reduce exposure to medications that can affect the QTc interval, computer algorithms have been successfully developed and implemented in critical care units at several hospitals. The purpose of this project is to disseminate and evaluate a risk score for QTc interval prolongation across all care units at 28 hospitals that have a high proportion of underserved American Indian, Latino, and economically disadvantaged populations, include rural critical access facilities.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Healthcare Information Technology Research (HITR)
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Lomotan, Edwin A
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University of Utah
Schools of Pharmacy
Salt Lake City
United States
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