Rapid Adjustment of Clinical Decision Support in Response to Updated Recommendations for Palivizumab Eligibility

Michel, Jeremy J.; Utidjian, Levon; Karavite, Dean; Hogan, Annique; Ramos, Mark; Miller, Jeffrey M.; Shiffman, Richard N.; Grundmeier, Robert W.

doi:10.4338/aci-2016-10-ra-0173

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…Iterative steps, complete with quality control activities, help to develop the content required for MIPS measure submission. This process supports versioning and updating 30 , 31 (for evidence changes, code set changes, and data model changes), which were extremely important as we navigated the drafts, revisions from public comment, validation testing, and changes in response to emerging technologies. Finally, the process is transparent, auditable, and potentially reproducible.…”

Section: Discussionmentioning

confidence: 99%

Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry‐Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

Michel

Schwartz

Dawson

et al. 2021

Otolaryngol.--head neck surg.

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Background and Significance Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. Methods We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. Results The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. Conclusion Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.

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Section: Discussionmentioning

confidence: 99%

Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry‐Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

Michel

Schwartz

Dawson

et al. 2021

Otolaryngol.--head neck surg.

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“…Our approach also allows CDS artifacts to be revised in response to changes in the evidence base or environmental changes that require reassessment of CDS implementation. 31 For instance, standardized clinical terminologies such as RxNorm (for medications) from which the value sets are created undergo weekly, monthly, and annual updates. 27,[32][33][34] By retaining the search algorithm used in the development of each of these value sets, this systematic process supports ongoing updates.…”

Section: Lesson 1: Publicly Available Software For Translating Guidelmentioning

confidence: 99%

Translation of a C. difficile Treatment Clinical Pathway Into Machine-Readable Clinical Decision Support Artifacts Prototyped for Electronic Health Record Integration

Michel¹,

Flores²,

Mull³

et al. 2091

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Purpose of Project To translate an evidence-based Clostridioides difficile* (CDI) treatment clinical pathway using a systematic, transparent process into machine readable clinical decision support (CDS) prototyped for electronic health record (EHR) integration. (*The bacterium Clostridium difficile was renamed Clostridioides difficile in August 2016.) Key Messages • Getting evidence into practice to improve clinical decision making remains an ongoing challenge. • We successfully translated a clinical pathway into machine readable CDS prototyped for EHR integration. • We used the CDS Authoring Tool on the CDS Connect website to translate this clinical pathway into Clinical Quality Language (CQL) shareable decision support. • Creating CDS artifacts from a clinical pathway informed by an EPC report may promote dissemination of work from AHRQ reports to a wide audience and support AHRQ's Learning Health System initiatives. iii This report is based on research conducted by the ECRI Institute-Penn Medicine Evidencebased Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00005-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Service None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. The information in this report is intended to help healthcare decision makers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

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“…9,20,25 Informatics-based interventions that can facilitate cross-systems collaboration and support ongoing communication are urgently needed. 16 Building on prior success in using an internally developed tool for ADHD monitoring by clinicians, [26][27][28][29][30] we sought to develop a system to improve communication between parents and teachers to decrease fragmentation of care. We targeted communication between parents and teachers due to recognition that this data exchange channel was unsupported by our electronic health record (EHR), and hypothesized that our current clinical decision support (CDS) could be modified to support this information sharing.…”

Section: Background and Significancementioning

confidence: 99%

Sharing of ADHD Information between Parents and Teachers Using an EHR-Linked Application

et al. 2018

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Background Appropriate management of attention-deficit/hyperactivity disorder (ADHD) involves parents, clinicians, and teachers. Fragmentation of interventions between different settings can lead to suboptimal care and outcomes. Electronic systems can bridge gaps across settings. Our institution developed an email-based software to collect ADHD information from parents and teachers, which delivered data directly to the clinician within the electronic health record (EHR). Objective We sought to adapt our institution's existing EHR-linked system for ADHD symptom monitoring to support communication between parents and teachers and then to assess child characteristics associated with sharing of ADHD information. Methods We updated our software to support automated sharing of ADHD information between parents and teachers. Sharing was optional for parents but obligatory for teachers. We conducted a retrospective cohort study involving 590 patients at 31 primary care sites to evaluate a system for sharing of ADHD-specific health information between parents and teachers. We used multivariable logistic regression to estimate associations between child characteristics and parental sharing. We further investigated the association between child characteristics and viewing of survey results delivered through the electronic communication system. Results Most parents (64%) elected to share survey results with teachers at the first opportunity and the vast majority (80%) elected to share all possible information. Parents who elected to share usually continue sharing at subsequent opportunities (89%). Younger child age and performance impairments were associated with increased likelihood of sharing. However, parents viewed only 16% of teacher submitted surveys and teachers only viewed 30% of surveys shared by parents. Conclusion This study demonstrates that electronic systems to capture ADHD information from parents and teachers can be adapted to support communication between them, and that parents are amenable to sharing ADHD information with teachers. However, strategies are needed to encourage viewing of shared information.

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Rapid Adjustment of Clinical Decision Support in Response to Updated Recommendations for Palivizumab Eligibility

Cited by 3 publications

References 25 publications

Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry‐Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry‐Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

Translation of a C. difficile Treatment Clinical Pathway Into Machine-Readable Clinical Decision Support Artifacts Prototyped for Electronic Health Record Integration

Sharing of ADHD Information between Parents and Teachers Using an EHR-Linked Application

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