Assessing the Relationship between Care Processes and Clinical Decision Support for Order Entry

评估护理流程与订单输入临床决策支持之间的关系

• 批准号: 10002228
• 负责人: Yiye Zhang
• 金额: $ 3.32万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10002228
• 关键词: Assessing; Relationship; between; Care; Processes

Project Summary Order sets are a CDS function which presents multiple orders for a particular clinical purpose as a set (such as an `Admission Order Set') for clinicians to select2. Order sets are expected to improve patient safety by reducing prescribing variations and errors, and also facilitate efficient order placement based on best practices and guidelines4,5. The creation of order sets has been considered a requirement for a successful CPOE implementation2,5,6. However, the association among order sets, their expected benefits, and barriers for their usage, is understudied.4,7,8 The goal of this pilot study is twofold. First, we will identify potential scenarios where the use of order sets leads to better outcomes than non-use of order sets, specifically opioid prescribing, by applying advanced data analytics to historical data. Data on order placement are extracted from electronic health records (EHR). In parallel, we will use a survey method to understand perceptions on order sets, in order to remove barriers to the use of this CDS tool which are often reported to not be utilized to its maximum benefit. In particular, we are interested in the role of order sets in the prescription of opioid medications during patients inpatient and emergency room (ER) visits. Our overarching hypothesis for this project is that order set use is associated with improved quality of care (i.e., fewer unexplained variations in care, and reduced opioid prescribing overall), yet clinician-level barriers are limiting uptake of this CDS modality. Analyses will be conducted on ordering data from the Department of Internal Medicine, Surgery, and Emergency Medicine. In Aim 1, we will assess the relationship between order set use and care variation within Internal Medicine, Surgery, and Emergency Medicine, respectively, while controlling for principal diagnoses, patient complexity, and campus locations. We hypothesize that more frequent use of order sets is associated with reduced care variations while controlling for principal diagnoses, patient complexity, and campus locations. In Aim 2, we will compare the number of opioids prescribed from order sets and prescribed as standalone orders. We hypothesize that more frequent use of order sets is associated with reduced opioid prescriptions while controlling for principal diagnoses, patient complexity, and campus locations. In Aim 3, a survey will be conducted with Internal Medicine, Surgery, and Emergency Medicine clinicians in 3 campuses associated with NYP Hospital. We hypothesize that trust and self-efficacy about order sets are associated with an increased order set use while controlling for satisfaction, level of experience, IT training, department, and campus location. Findings from this study may lay the groundwork for prospective large-scale and interventional studies to strategize safe and efficient opioid prescriptions through order sets that have sufficient clinician uptake.

项目摘要 订单集是一个CDS函数，它将用于特定临床目的的多个订单作为一个集合呈现 (such作为“入院顺序集”）供临床医生选择2.订单集有望提高患者安全性 通过减少处方变化和错误，还有助于基于最佳 实践和指导方针4，5.订单集的创建被认为是成功的 CPOE实施2，5，6.然而，订单集之间的关联，它们的预期收益，以及 4，7，8这项试点研究的目标是双重的。首先，我们将确定潜在的场景 在使用顺序集导致比不使用顺序集更好的结果，特别是阿片类药物处方， 将先进的数据分析应用于历史数据。有关下单的数据摘录自电子 健康记录（EHR）。与此同时，我们将使用调查方法来了解对顺序集的看法， 为了消除使用这一CDS工具的障碍，据报道，这一工具往往没有得到最大限度的利用 效益特别是，我们感兴趣的是在阿片类药物的处方过程中，订单集的作用。 患者住院和急诊室（ER）就诊。我们对这个项目的总体假设是， 使用与改善的护理质量相关（即，减少护理中无法解释的变化，减少阿片类药物 总体处方），但临床医生水平的障碍限制了这种CDS模式的采用。分析将 根据从内科、外科和急诊科订购的数据进行。在 目的1，我们将评估订单集的使用和内科护理差异之间的关系， 外科和急诊医学，同时控制主要诊断，病人的复杂性， 和校园位置。我们假设更频繁地使用顺序集与减少护理有关 变化，同时控制主要诊断，病人的复杂性和校园的位置。在目标2中，我们将 比较从成套订单中开出的阿片类药物数量和作为独立订单开出的阿片类药物数量。我们 假设更频繁地使用订单集与减少阿片类药物处方有关， 控制主要诊断、患者复杂性和校园位置。在目标3中，将进行一项调查， 与3个校区的内科、外科和急诊科临床医生一起进行， NYP医院我们假设，关于顺序集的信任和自我效能感与增加的 在控制满意度、经验水平、IT培训、部门和园区的同时使用订单集 位置.这项研究的结果可能为前瞻性大规模和干预性研究奠定基础 通过有足够临床医生接受的订单集制定安全有效的阿片类药物处方。