Domain

Learning Health System

Type

Empirical Study

Theme

notapplicable

Start Date

7-6-2014 1:15 PM

End Date

7-6-2014 2:45 PM

Structured Abstract

INTRODUCTION

The integration of clinical prediction rules (CPRs) at the point of care aids in translating evidence based medicine into clinical practice. CPRs can be defined as validated tools that quantify the individual contributions that components of history, physical, and laboratory results make towards a diagnosis, prognosis or treatment response. Integration of CPRs into electronic health systems has shown some success, yet adoption continues to be a significant barrier. This study sought to examine health care provider preferences for CPRs based on specialty and level of training.

METHODS

The survey was piloted, followed by online distribution to attending physicians and residents in Internal (IM) and Emergency Medicine (EM). After modifications to the survey from pilot testing, an e- mail with the online link was widely distributed. The study period ran from January 1st until May 31st, 2013 within two academic centers. The Institutional Review Boards at North Shore-LIJ and Boston University approved the research as an exempted project.

The chi-square test and Fisher’s Exact test, were used to explore the association between each of the categorical questionnaire items and the key variables of interest. The Mann Whitney and Wilcoxon test were used to compare the target groups on the continuous variables. Finally, the Spearman correlation was used to measure the correlation between the usefulness of the CPR and selected ordinal variables.

FINDINGS

Participants from both academic centers were similarly divided between IM and EM specialties. Attending physicians comprised approximately 40% of participants and house staff constituted the remaining 60%. There was a male predominance which paralleled national US physician data, where only about one third of MDs are women.

The ten CPRs that were ranked most familiar were CAGE, Apache II, CHADS2, CURB 65, MELD, Ottawa Ankle, Ranson’s, TIMI Score (NSTEMI), Wells for DVT and PE. The CPRs with a significant difference in usefulness score across specialties were the Ottawa Ankle Rule and Wells Score for PE, both ranked higher by EM providers. There was no significant differences in the usefulness score of any CPR across training level. Interestingly, providers working in mostly inpatient settings rated the 4T Score for Heparin-induced Thrombocytopenia as significantly more useful. While, providers working mostly in outpatient settings rated the Walsh score as significantly more useful.

DISCUSSION

Health care providers surveyed in this study reported clear preferences for certain CPRs. Improved clinical care as well as decreased costs are potential results of integrating provider preferred CPRs into electronic health systems. The United States spends nearly double the average, $3,923, of all OECD countries, however American patients receive about 55% of recommended clinical care. Overtreatment and failures in execution of care processes are partially responsible for waste in health care spending, estimated as exceeding 20%. The consideration of these preferences would be paramount in identifying specific CPRs that could be integrated into an electronic health system with high adoption rates by providers.

CONCLUSION

Understanding provider preferences may help to address limiting factors in meaningful integration of clinical decision support into our electronic health systems.

Acknowledgements

N/A

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Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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Jun 7th, 1:15 PM Jun 7th, 2:45 PM

Healthcare Provider Perceptions of Clinical Prediction Rules

INTRODUCTION

The integration of clinical prediction rules (CPRs) at the point of care aids in translating evidence based medicine into clinical practice. CPRs can be defined as validated tools that quantify the individual contributions that components of history, physical, and laboratory results make towards a diagnosis, prognosis or treatment response. Integration of CPRs into electronic health systems has shown some success, yet adoption continues to be a significant barrier. This study sought to examine health care provider preferences for CPRs based on specialty and level of training.

METHODS

The survey was piloted, followed by online distribution to attending physicians and residents in Internal (IM) and Emergency Medicine (EM). After modifications to the survey from pilot testing, an e- mail with the online link was widely distributed. The study period ran from January 1st until May 31st, 2013 within two academic centers. The Institutional Review Boards at North Shore-LIJ and Boston University approved the research as an exempted project.

The chi-square test and Fisher’s Exact test, were used to explore the association between each of the categorical questionnaire items and the key variables of interest. The Mann Whitney and Wilcoxon test were used to compare the target groups on the continuous variables. Finally, the Spearman correlation was used to measure the correlation between the usefulness of the CPR and selected ordinal variables.

FINDINGS

Participants from both academic centers were similarly divided between IM and EM specialties. Attending physicians comprised approximately 40% of participants and house staff constituted the remaining 60%. There was a male predominance which paralleled national US physician data, where only about one third of MDs are women.

The ten CPRs that were ranked most familiar were CAGE, Apache II, CHADS2, CURB 65, MELD, Ottawa Ankle, Ranson’s, TIMI Score (NSTEMI), Wells for DVT and PE. The CPRs with a significant difference in usefulness score across specialties were the Ottawa Ankle Rule and Wells Score for PE, both ranked higher by EM providers. There was no significant differences in the usefulness score of any CPR across training level. Interestingly, providers working in mostly inpatient settings rated the 4T Score for Heparin-induced Thrombocytopenia as significantly more useful. While, providers working mostly in outpatient settings rated the Walsh score as significantly more useful.

DISCUSSION

Health care providers surveyed in this study reported clear preferences for certain CPRs. Improved clinical care as well as decreased costs are potential results of integrating provider preferred CPRs into electronic health systems. The United States spends nearly double the average, $3,923, of all OECD countries, however American patients receive about 55% of recommended clinical care. Overtreatment and failures in execution of care processes are partially responsible for waste in health care spending, estimated as exceeding 20%. The consideration of these preferences would be paramount in identifying specific CPRs that could be integrated into an electronic health system with high adoption rates by providers.

CONCLUSION

Understanding provider preferences may help to address limiting factors in meaningful integration of clinical decision support into our electronic health systems.