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

项目摘要 医嘱集是一种CDS函数，它将特定临床用途的多个医嘱表示为一个集合 (如‘接纳顺序集’)供临床医生选择。医嘱集有望提高患者的安全性 通过减少处方差异和错误，并促进基于最佳的高效下单 实践和准则4、5.订单集的创建一直被认为是成功 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这项先导研究的目的是双重的。首先，我们将确定潜在的情景 如果使用有序集比不使用有序集产生更好的结果，特别是阿片类药物处方， 通过将高级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)。同时，我们将使用调查方法来了解人们对顺序集的看法，在 以消除使用这一CDS工具的障碍，这些障碍经常被报告为没有得到最大限度的利用 利益。特别是，我们感兴趣的是有序集在阿片类药物处方中的作用 患者住院和急诊室(ER)就诊。我们对这个项目的主要假设是订单集 使用与改善护理质量有关(即，护理中原因不明的变化较少，阿片类药物减少 总体来说)，但临床医生层面的障碍限制了这种CDS模式的采用。分析将是 对内科、外科和急诊医学部的数据进行了排序。在……里面 目标1，我们将评估医嘱集使用与内科护理差异之间的关系， 外科和急诊医学，在控制主要诊断、患者复杂性、 和校园位置。我们假设，更频繁地使用有序集与减少护理有关 在控制主要诊断、患者复杂性和园区位置的同时进行变化。在目标2中，我们将 比较从订单集开出的阿片类药物的数量和作为独立订单开出的阿片类药物的数量。我们 假设更频繁地使用有序集与阿片类药物处方的减少相关，而 控制主要诊断、患者复杂性和园区位置。在目标3中，将进行一项调查 与内科、外科和急诊临床医生在3个校区开展合作， 纽约医院。我们假设对有序集的信任和自我效能感与增加的 在控制满意度、体验水平、IT培训、部门和园区的同时使用订单集 地点。这项研究的发现可能为未来的大规模和干预性研究奠定基础 通过有足够临床医生吸收的医嘱集来制定安全有效的阿片类药物处方战略。

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.