An Industrial Process View of Information Delivery to Support Clinical Decision Making: Implications for Systems Design and Process Measures

Elson, Robert B.; Faughnan, John G.; Connelly, Donald P.

doi:10.1136/jamia.1997.0040266

Cited by 50 publications

(26 citation statements)

References 79 publications

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“…We targeted specific steps in the process of asthma care that were considered critical to the success of improvement. 21 We did not formally use techniques such as academic detailing or use of opinion leaders, although the ED clinical leadership for physicians and nursing staff was supportive of the technology deployment. Despite our efforts to identify key process-level barriers and implement a supportive infrastructure, the ability of individual ED providers to accept and incorporate a technology-derived "to-do" list into their communication with patients was limited.…”

Section: Discussionmentioning

confidence: 99%

Impact of Patient-Centered Decision Support on Quality of Asthma Care in the Emergency Department

et al. 2006

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OBJECTIVE. Communication barriers between parents of children with asthma and clinical emergency department (ED) providers and subsequent underrecognition of chronicity and severity impede improvements in disease management for patients with asthma in the ED setting. The asthma kiosk, a novel patient-driven decision-support tool, provides ED clinicians with tailored recommendations for guideline-based treatment. We evaluated the impact of the asthma kiosk on measures of quality during ED care, specifically, parent-reported satisfaction with dimensions of care related to communication and providers' adoption of guidelineendorsed processes of care. METHODS.A clinical trial composed of a baseline and an intervention period was conducted at a single tertiary care pediatric ED. Eligible participants were Englishor Spanish-speaking parents of children who were 1 to 12 years of age and had a respiratory complaint and history of asthma. Parents used the kiosk to report children's symptoms, current medications, and unmet needs. During a 2-month baseline, no output from the kiosk was shared, and usual care proceeded. During a 3-month intervention that followed a 1-week run-in period, the output was shared with ED clinicians. All parents completed a telephone follow-up interview 1 week after discharge. Primary outcomes were (1) prescription of controller medication to patients who had persistent asthma symptoms and were not on controllers and (2) mean problem scores for 2 specific dimensions of care: information-sharing and partnership.RESULTS. Over 5 months, 1090 parent-child dyads were screened and 430 were eligible. A total of 286 (66.5%) of 430 parents enrolled in the trial. The kiosk generated severity classifications for 264 (92.3%) of 286 children. A total of 131 parents enrolled during baseline, 13 during a 1-week test phase, and 142 during intervention. Baseline participants were older (mean age: 5.3 years) compared with intervention (4.4 years) but did not differ on chronic severity, current use of controllers, or race. The total number of prescribed inhaled corticosteroids did not vary significantly between intervention and baseline (9 of 50 vs 4 of 43). Providers did prescribe inhaled fluticasone to eligible patients more often during intervention than baseline (9 of 50 vs 2 of 43). The number of reported information problems was unchanged between the baseline and intervention periods. The mean number of partnership problems increased from a mean of 1.5 (SD: 1.9) at baseline to a mean of 1.9 (SD: 1.4) during the intervention. This difference was marginally significant after adjustment for child gender, age, and severity category. When ED providers acted on kiosk data, reports of information problems were fewer (0.6 Ϯ 0.8) than when no action was taken (1.1 Ϯ 1.1).CONCLUSIONS. The asthma kiosk demonstrated small and variable impact on quality. Physicians' nonuse of kioskgenerated recommendations may explain the limited impact of the intervention. O PTIMAL HEALTH CARE requires effective collaboration betw...

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Section: Discussionmentioning

confidence: 99%

Impact of Patient-Centered Decision Support on Quality of Asthma Care in the Emergency Department

et al. 2006

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“…7 Medical decision making is aided by targeted knowledge brought to the point of care. 8 This Bjust-in-time^learning helps promote evidence-based radiology, where scientific knowledge is linked to radiology practice. 9 Educational theory and empirical evidence support the use of Bsituated learning,^in which the learning experience is imparted where the knowledge is used.…”

Section: Discussionmentioning

confidence: 99%

A Presentation System for Just-in-time Learning in Radiology

Kahn

Santos

Thao³

et al. 2006

J Digit Imaging

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There is growing interest in bringing medical educational materials to the point of care. We sought to develop a system for just-in-time learning in radiology. A database of 34 learning modules was derived from previously published journal articles. Learning objectives were specified for each module, and multiple-choice test items were created. A web-based system-called TEM-PO-was developed to allow radiologists to select and view the learning modules. Web services were used to exchange clinical context information between TEMPO and the simulated radiology work station. Preliminary evaluation was conducted using the System Usability Scale (SUS) questionnaire. TEMPO identified learning modules that were relevant to the age, sex, imaging modality, and body part or organ system of the patient being viewed by the radiologist on the simulated clinical work station. Users expressed a high degree of satisfaction with the system's design and user interface. TEMPO enables just-in-time learning in radiology, and can be extended to create a fully functional learning management system for point-of-care learning in radiology.

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“…10,11 The American Medical Association has recently endorsed point-of-care educational interventions, including Internet searching and independent learning, that lead to performance improvement. 12 Medical decision making is aided by immediate, targeted information delivered at the point of care. 13 Interactive and contextually relevant (''situated'') CME can improve knowledge, skills, attitudes, behavior, and health care outcomes.…”

Section: Discussionmentioning

confidence: 99%

Radiologists' Preferences for Just-in-Time Learning

2006

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Background: Effective learning can occur at the point of care, when opportunities arise to acquire information and apply it to a clinical problem. To assess interest in point-of-care learning, we conducted a survey to explore radiologists' attitudes and preferences regarding the use of just-in-time learning (JITL) in radiology. Materials and Methods: Following Institutional Review Board approval, we invited 104 current radiology residents and 86 radiologists in practice to participate in a 12-item Internet-based survey to assess their attitudes toward just-in-time learning. Voluntary participation in the survey was solicited by e-mail; respondents completed the survey on a web-based form. Results: Seventy-nine physicians completed the questionnaire, including 47 radiology residents and 32 radiologists in practice; the overall response rate was 42%. Respondents generally expressed a strong interest for JITL: 96% indicated a willingness to try such a system, and 38% indicated that they definitely would use a JITL system. They expressed a preference for learning interventions of 5Y10 min in length. Conclusions: Current and recent radiology trainees have expressed a strong interest in just-in-time learning. The information from this survey should be useful in pursuing the design of learning interventions and systems for delivering just-in-time learning to radiologists.

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An Industrial Process View of Information Delivery to Support Clinical Decision Making: Implications for Systems Design and Process Measures

Cited by 50 publications

References 79 publications

Impact of Patient-Centered Decision Support on Quality of Asthma Care in the Emergency Department

Impact of Patient-Centered Decision Support on Quality of Asthma Care in the Emergency Department

A Presentation System for Just-in-time Learning in Radiology

Radiologists' Preferences for Just-in-Time Learning

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