Clinical dashboard development and use for academic detailing in the U.S. Department of Veterans Affairs

Lau, Marcos K.; Bounthavong, Mark; Kay, Chad L.; Harvey, Michael; Christopher, Melissa L.D.

doi:10.1016/j.japh.2018.12.006

Cited by 30 publications

(20 citation statements)

References 20 publications

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“…However, in most cases, these dashboards have been designed specifically for academic detailers as the primary end users, enhancing their ability to identify actionable patients before interacting with practitioners. 32 To our knowledge, the EQUIPPED dashboard is the first information display of its kind with built-in audit and feedback that has been developed for VA ED practitioners as the primary end users.…”

Section: Discussionmentioning

confidence: 99%

The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) Potentially Inappropriate Medication Dashboard: A Suitable Alternative to the In-person Academic Detailing and Standardized Feedback Reports of Traditional EQUIPPED?

Burningham

Jackson

Kelleher

et al. 2020

Clinical Therapeutics

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Purpose: The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) program is a quality improvement initiative that combines education, clinical decision support (ie, geriatric pharmacy order sets), and in-person academic detailing coupled with audit and feedback in an effort to improve appropriate prescribing to older veterans discharged from the emergency department. Although the EQUIPPED program is effective at reducing the prescribing of potentially inappropriate medications, the reliance on inperson academic detailing may be a limitation for broader dissemination. The EQUIPPED dashboard is a passive yet continuous audit and feedback mechanism developed to potentially replace the in-person academic detailing of the traditional EQUIPPED program. We describe the development process of the EQUIPPED dashboard and the key audit and feedback components found within.

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Section: Discussionmentioning

confidence: 99%

The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) Potentially Inappropriate Medication Dashboard: A Suitable Alternative to the In-person Academic Detailing and Standardized Feedback Reports of Traditional EQUIPPED?

Burningham

Jackson

Kelleher

et al. 2020

Clinical Therapeutics

View full text Add to dashboard Cite

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“…Dashboards developed with input from end-users, leadership, and subject matter experts have a greater chance of being adopted and have higher user acceptance. 21,36,37 The project team used structured and unstructured VA data to develop the dashboard. The dashboard presents data via a clear mechanistic interface and allows users to see comparisons between hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…18,19 The use of dashboards within the VA has enabled the ability to implement system-wide processes for both population management and quality improvement. 18,20,21 Dashboards that utilize both structured and unstructured data can produce patient-specific risk assessments and support guideline-directed medical therapy (GDMT) recommendations leading to greater evidence-based care. [22][23][24] Previous studies have demonstrated the efficacy of using multiple identifiers in algorithms or from notes using natural language processing (NLP) for identifying patient phenotype for early diagnosis of HF.…”

Section: Background and Significancementioning

confidence: 99%

Heart Failure Dashboard Design and Validation to Improve Care of Veterans

et al. 2020

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Background Early electronic identification of patients at the highest risk for heart failure (HF) readmission presents a challenge. Data needed to identify HF patients are in a variety of areas in the electronic medical record (EMR) and in different formats. Objective The purpose of this paper is to describe the development and data validation of a HF dashboard that monitors the overall metrics of outcomes and treatments of the veteran patient population with HF and enhancing the use of guideline-directed pharmacologic therapies. Methods We constructed a dashboard that included several data points: care assessment need score; ejection fraction (EF); medication concordance; laboratory tests; history of HF; and specified comorbidities based on International Classification of Disease (ICD), ninth and tenth codes. Data validation testing with user test scripts was utilized to ensure output accuracy of the dashboard. Nine providers and key senior management participated in data validation. Results A total of 43 medical records were reviewed and 66 HF dashboard data discrepancies were identified during development. Discrepancies identified included: generation of multiple EF values on a few patients, missing or incorrect ICD codes, laboratory omission, incorrect medication issue dates, patients incorrectly noted as nonconcordant for medications, and incorrect dates of last cardiology appointments. Continuous integration and builds identified defects—an important process of the verification and validation of biomedical software. Data validation and technical limitations are some challenges that were encountered during dashboard development. Evaluations by testers and their focused feedback contributed to the lessons learned from the challenges. Conclusion Continuous refinement with input from multiple levels of stakeholders is crucial to development of clinically useful dashboards. Extraction of all relevant information from EMRs, including the use of natural language processing, is crucial to development of dashboards that will help improve care of individual patients and populations.

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“…A thorough review of inpatient prescribing might identify providers who would benefit from pharmacist-led academic detailing or training in additional resources to manage anxiety and sleep in the hospital. 25,26 In direct contrast to high-intensity prescribers, researchers have identified low-intensity prescribers who prescribe at a lower volume than their peers. 27 In our study, we found that the majority of providers were not triggering the alert more than a few times per year, suggesting that the vast majority of clinicians are not prescribing benzodiazepines contrary to guidelines.…”

Section: Insights About Provider-alert Response Behaviormentioning

confidence: 99%

Evaluation of Clinical Decision Support to Reduce Sedative-Hypnotic Prescribing in Older Adults

2021

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Objective We sought to characterize the performance of inpatient and outpatient computerized clinical decision support (CDS) alerts aimed at reducing inappropriate benzodiazepine and nonbenzodiazepine sedative medication prescribing in older adults 18 months after implementation. Methods We reviewed the performance of two CDS alerts in the outpatient and inpatient settings in 2019. To examine the alerts' effectiveness, we analyzed metrics including overall alert adherence, provider-level adherence, and reasons for alert trigger and override. Results In 2019, we identified a total of 14,534 and 4,834 alerts triggered in the outpatient and inpatient settings, respectively. Providers followed only 1% of outpatient and 3% of inpatient alerts. Most alerts were ignored (68% outpatient and 60% inpatient), while providers selected to override the remaining alerts. In each setting, the top 2% of clinicians were responsible for approximately 25% of all ignored or overridden alerts. However, a small proportion of clinicians (2% outpatient and 4% inpatient) followed the alert at least half of the time and accounted for a disproportionally large fraction of the total followed alerts. Our analysis of the free-text comments revealed that many alerts were to continue outpatient prescriptions or for situational anxiety. Conclusion Our findings highlight the importance of evaluation of CDS performance after implementation. We found large variation in response to the inpatient and outpatient alerts, both with respect to follow and ignore rates. Reevaluating the alert design by providing decision support by indication may be more helpful and may reduce alert fatigue.

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Clinical dashboard development and use for academic detailing in the U.S. Department of Veterans Affairs

Cited by 30 publications

References 20 publications

The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) Potentially Inappropriate Medication Dashboard: A Suitable Alternative to the In-person Academic Detailing and Standardized Feedback Reports of Traditional EQUIPPED?

The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) Potentially Inappropriate Medication Dashboard: A Suitable Alternative to the In-person Academic Detailing and Standardized Feedback Reports of Traditional EQUIPPED?

Heart Failure Dashboard Design and Validation to Improve Care of Veterans

Evaluation of Clinical Decision Support to Reduce Sedative-Hypnotic Prescribing in Older Adults

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