Electronic health record-embedded decision support to reduce stroke risk in patients with atrial fibrillation – Study protocol

Eckman, Mark H.; Wise, R.; Knochelmann, Carol; Mardis, Rachael; Wright, Sharon B.; Gummadi, Ashish; Dixon, Estrelita; Becker, Richard C.; Schauer, Daniel P.; Flaherty, Matthew L.; Costea, Alexandru; Kleindorfer, Dawn; Ireton, Robert C.; Baker, Pete; Harnett, Brett; Adejare, Adeboye; Leonard, Anthony; Sucharew, Heidi; Costanzo, Amy J.; Arduser, Lora; Kues, John R.

doi:10.1016/j.ahj.2022.01.012

Cited by 2 publications

(3 citation statements)

References 49 publications

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“…BPAs are being tested and used in other areas of prevention. Another recently published study protocol embeds a BPA in the EHR to improve appropriate thromboprophylaxis in patients with atrial fibrillation (Eckman et al, 2022). Patients are randomized to one of two arms: usual care, where current treatment guidelines are available to their HCP, or to the treatment arm, where adding a BPA will notify the HCPs of the benefit of changing the patient’s current thromboprophylactic therapy.…”

Section: Discussionmentioning

confidence: 99%

Implementing a Clinical Decision Support Tool to Improve Physical Activity

McCarthy,

Szerencsy,

Taza-Rocano

et al. 2024

Nursing Research

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Background Currently, only about half of U.S. adults achieve current physical activity guidelines. Routine physical activity is not regularly assessed, nor are patients routinely counseled by their health care provider on achieving recommended levels. The three-question physical activity vital sign (PAVS) was developed to assess physical activity duration and intensity and identify adults not meeting physical activity guidelines. Clinical decision support provided via a best practice advisory in an electronic health record (EHR) system can be triggered as a prompt, reminding health care providers to implement the best practice intervention when appropriate. Remote patient monitoring of physical activity can provide objective data in the EHR. Objectives This study aimed to evaluate the feasibility and clinical utility of embedding the PAVS and a triggered best practice advisor into the EHR in an ambulatory preventive cardiology practice setting to alert providers to patients reporting low physical activity and prompt health care providers to counsel these patients as needed. Methods Three components based in the EHR were integrated for the purpose of this study: patients completed the PAVS through their electronic patient portal prior to an office visit; a best practice advisory was created to prompt providers to counsel patients who reported low levels of physical activity; and remote patient monitoring via Fitbit synced to the EHR provided objective physical activity data. The intervention was pilot-tested in the Epic EHR for 1 year (July 1, 2021–June 30, 2022). Qualitative feedback on the intervention from both providers and patients was obtained at the completion of the study. Results Monthly assessments of the use of the PAVS and best practice advisory and remote patient monitoring were completed. Patients’ completion of the PAVS varied from 35% to 48% per month. The best practice advisory was signed by providers between 2% and 65% and was acknowledged by 2% to 22% per month. The majority (58%) of patients were able to sync a Fitbit device to their EHR for remote monitoring. Discussion Although uptake of each component needs improvement, this pilot demonstrated the feasibility of incorporating a PA promotion intervention into the EHR. Qualitative feedback provided guidance for future implementation.

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Section: Discussionmentioning

confidence: 99%

Implementing a Clinical Decision Support Tool to Improve Physical Activity

McCarthy,

Szerencsy,

Taza-Rocano

et al. 2024

Nursing Research

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“…19 BPAs can also be used as clinical decision support tools, integrating data from a patient's medical record to help guide best practice specific to an individual patient and tied to specific actions taken on the part of the provider, such as prescribing appropriate thromboprophylaxis in patients with atrial fibrillation. 23 Additionally, BPAs requiring acknowledgment have been shown to be more effective in increasing rates of provider interaction with the BPA and increasing the intended action, such as prescribing appropriate blood pressure medications in patients with diabetes. 20 Given the appeal of BPA alerts, it is also important to keep in mind the potential downsides, which largely pertain to alert fatigue, a problem in which providers may pay less attention to alerts over time, thus limiting Note: Survey conducted using a 7-point Likert scale (1 = strongly disagree; 4 = neither agree nor disagree; 7 = strongly agree).…”

Section: Discussionmentioning

confidence: 99%

“…BPA use has effectively improved rates of provider adherence to national society guidelines in other specialties, such as recommended routine screening in Down syndrome 19 . BPAs can also be used as clinical decision support tools, integrating data from a patient's medical record to help guide best practice specific to an individual patient and tied to specific actions taken on the part of the provider, such as prescribing appropriate thromboprophylaxis in patients with atrial fibrillation 23 . Additionally, BPAs requiring acknowledgment have been shown to be more effective in increasing rates of provider interaction with the BPA and increasing the intended action, such as prescribing appropriate blood pressure medications in patients with diabetes 20 …”

Section: Discussionmentioning

confidence: 99%

A quality improvement initiative to improve folic acid supplementation counseling for adolescent females with epilepsy

Molisani

Parikh²,

DiGiovine

et al. 2023

Epilepsia

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ObjectiveWe designed a quality improvement (QI) project to improve rates of documented folic acid supplementation counseling for adolescent females with epilepsy, consistent with a quality measure from the American Academy of Neurology and American Epilepsy Society. Our SMART aim was to increase the percentage of visits at which folic acid counseling was addressed from our baseline rate of 23% to 50% by July 1, 2020.MethodsThis initiative was conducted in female patients ≥12 years old with epilepsy who were prescribed daily antiseizure medication and were seen by the 13 providers in our Neurology QI Program. Using provider interviews, we undertook a root cause analysis of low counseling rates and identified the following main factors: insufficient time during clinic visit to counsel, lack of provider knowledge, and forgetting to counsel. Countermeasures were designed to address these main root causes and were implemented through iterative plan–do–study–act (PDSA) cycles. Interventions included provider education and features within the electronic health record, which were introduced sequentially, culminating in the creation of a best practice advisory (BPA). We performed biweekly chart reviews of visits for applicable patients to establish baseline performance rate and track progress over time. We used a statistical process control p‐chart to analyze the outcome measure of documented counseling. As a balancing measure, clinicians were surveyed using the Technology Adoption Model survey to assess acceptance of the BPA.ResultsFrom September 2019 to August 2022, the QI team improved rates of documented folic acid counseling from 23% to 73% through several PDSA cycles. This level of performance has been sustained over time. The most successful and sustainable intervention was the BPA. Provider acceptance of the BPA was overall positive.SignificanceWe successfully used QI methodology to improve and sustain our rates of documented folic acid supplementation counseling for adolescent females with epilepsy.

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Electronic health record-embedded decision support to reduce stroke risk in patients with atrial fibrillation – Study protocol

Cited by 2 publications

References 49 publications

Implementing a Clinical Decision Support Tool to Improve Physical Activity

Implementing a Clinical Decision Support Tool to Improve Physical Activity

A quality improvement initiative to improve folic acid supplementation counseling for adolescent females with epilepsy

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