Adaptation and pilot implementation of a validated, electronic real time clinical decision support tool for care of Pneumonia patients in 12 Utah Urgent Care Centers

适应并试点实施经过验证的电子实时临床决策支持工具，用于犹他州 12 个紧急护理中心的肺炎患者护理

• 批准号: 10268162
• 负责人: NATHAN C DEAN
• 金额: $ 44.4万
• 依托单位: IHC HEALTH SERVICES, INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10268162
• 关键词: Adaptation; pilot; implementation; validated; electronic

Project Summary Clinicians’ ability to accurately diagnose pneumonia and choose appropriate treatment is enhanced by well- designed clinical decision support (CDS), thereby increasing patient safety. Pneumonia CDS has historically been focused on inpatient settings, but ambulatory care settings with high pneumonia patient volumes and different care processes also need CDS. We propose to adapt and evaluate an innovative, validated electronic clinical decision support (CDS) tool based on consensus guidelines for pneumonia (ePNa) to urgent care centers (UCC). The proposal supports four aims: 1) Adapt ePNa for UCC and after in silico testing, pilot it among “super user” clinicians during UCC shifts and assess its usability. ePNa needs adaptation for the limited patient data available in UCC, calibration of severity measures for lower observed mortality, and a chest imaging prompt in patients with pneumonia signs and symptoms. ePNa for UCC will incorporate the artificial intelligence CheXpert model to provide real-time (within seconds) electronic classification of chest images for elements of pneumonia diagnosis and treatment (radiographic pneumonia, single vs multiple lobes, and pleural effusion). 2) Use the CFIR framework, a focus group of UCC clinicians, and workflow observations to identify barriers and facilitators to adaptation and implementation of ePNa to UCC. 3) Test the implementation strategy by deploying ePNa at one of two randomly chosen Intermountain Healthcare UCC clusters each with about 800 annual pneumonia patients - the other a usual care control. 4) Co-primary outcomes are a) Patients diagnosed with pneumonia without chest imaging will be ≥50% lower in the ePNa cluster. b) Antibiotic prescribing for treatment of pneumonia will be ≥90% consistent with consensus guidelines and higher in the ePNa cluster. Safety measures will be unplanned subsequent 7-day ED visits/hospitalizations and 30-day mortality. Based on this rigorous pilot study, we anticipate a subsequent multi-system cluster-randomized trial including Cerner systems outside Utah. Our work incorporates the Five Rights of CDS to ensure that the strengths of this technology are optimized in the clinical environment. We will leverage experience in innovative pneumonia research, pioneering CDS, and implementation science available at Intermountain to successfully complete this proposal. The proposal will be facilitated by and disseminated through Intermountain relationships with the PCORnet Learning Health Systems Network, PCOR CDS Learning Network, the Healthcare Services Platform Consortium, Cerner, and clinicaltrials.gov. Our innovative proposal promises to advance safety for patients suspected of pneumonia in an understudied, high-volume ambulatory care setting.

项目总结