? ? When computerized provider order entry (CPOE) is coupled with real-time computer-based decision support (CDS), medical errors decrease and costs can drop because clinicians can be alerted to potential errors or guided to select lower cost medications and tests. CPOE with CDS is not in widespread use in community hospitals. Since 96% of U.S. hospitals are in this category, the implementation gap between community and teaching hospitals has serious consequences for patient safety. In our prior research, we have shown CPOE's lack of diffusion involves a complex web of technical, organizational, and contextual issues and that a large number of adverse consequences of CPOE result from CDS. This revised competing continuation proposal from the CPOE research teams at OHSU and Brigham and Women's Hospital outlines three aims, within a systems theory framework, to examine CDS in community hospitals, and to quickly disseminate knowledge about what does and does not work. The research is designed to answer key questions about improving CDS and CPOE: ? ? What do experts view as the barriers and facilitators related to CDS in these hospitals? ? How do the barriers and facilitators the experts describe compare with those identified during fieldwork at community hospitals? ? What is the best way to synthesize expert and field results into useful, widely disseminated CDS implementation and operational guidance tools, and to persuade and inspire others to adopt best problem solving practices? ? ? Specific Aims ? AIM 1: With the assistance of a multidisciplinary panel of CDS experts, detail the barriers and facilitators to CDS use in community hospitals, including personal, organizational, technological, and knowledge management aspects. ? AIM 2. Using a mixed methods approach we call the Expedited Assessment Procedure, identify the barriers and facilitators at 8-10 community hospitals. Compare and synthesize the expert and fieldwork results with those from Aim 1 and plan and draft CDS guidance tools. ? AIM 3. With help from the panel of experts and community hospital representatives, finalize and widely disseminate CDS tools that can be used by community hospital staff to facilitate future CDS implementations by reducing barriers and strengthening facilitators. ? ? ? ?
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