Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule iCPR randomized trial in primary careReport as inadecuate




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Implementation Science

, 6:109

First Online: 19 September 2011Received: 13 July 2011Accepted: 19 September 2011DOI: 10.1186-1748-5908-6-109

Cite this article as: Mann, D.M., Kannry, J.L., Edonyabo, D. et al. Implementation Sci 2011 6: 109. doi:10.1186-1748-5908-6-109

Abstract

BackgroundClinical prediction rules CPRs represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record EHR has been a major limitation and we are not aware of a study demonstrating the use of CPR-s in an ambulatory EHR setting. The integrated clinical prediction rule iCPR trial integrates two CPR-s in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting.

MethodsA multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support CDS tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of -real world- usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers n = 149 were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control simulated groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates strep and pneumonia iCPR-s encounters and chest x-rays pneumonia iCPR only between intervention and control providers.

DiscussionUsing iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative process will lead to higher rates of utilization and EBM guided use of antibiotics and chest x-ray-s in primary care.

Trial RegistrationClinicalTrials.gov Identifier NCT01386047

Electronic supplementary materialThe online version of this article doi:10.1186-1748-5908-6-109 contains supplementary material, which is available to authorized users.

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Author: Devin M Mann - Joseph L Kannry - Daniel Edonyabo - Alice C Li - Jacqueline Arciniega - James Stulman - Lucas Romero - Ju

Source: https://link.springer.com/



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