Appl Clin Inform 2023; 14(05): 822-832
DOI: 10.1055/s-0043-1775566
Research Article

Sustained Effect of Clinical Decision Support for Heart Failure: A Natural Experiment Using Implementation Science

Katy E. Trinkley
1   Department of Family Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
2   UCHealth, Aurora, Colorado, United States
3   Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
,
Garth Wright
3   Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
,
Larry A. Allen
4   Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
5   Division of Cardiology, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
,
Tellen D. Bennett
4   Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
6   Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Russell E. Glasgow
1   Department of Family Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
4   Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
7   Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, United States
,
Gary Hale
2   UCHealth, Aurora, Colorado, United States
,
Simeon Heckman
2   UCHealth, Aurora, Colorado, United States
,
Amy G. Huebschmann
4   Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
8   Division of Internal Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
9   University of Colorado Anschutz Medical Campus Ludeman Family Center for Women's Health Research, Aurora, Colorado, United States
,
Michael G. Kahn
6   Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, Colorado, United States
,
David P. Kao
2   UCHealth, Aurora, Colorado, United States
3   Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
,
Chen-Tan Lin
2   UCHealth, Aurora, Colorado, United States
8   Division of Internal Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
,
Daniel C. Malone
10   Department of Pharmacotherapy, University of Utah Skaggs College of Pharmacy, Salt Lake City, Utah, United States
,
Daniel D. Matlock
4   Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
7   Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, United States
8   Division of Internal Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
11   Division of Geriatrics, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
,
Lauren Wells
3   Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
,
Vincent Wysocki
3   Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
,
Shelley Zhang
1   Department of Family Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, United States
,
Krithika Suresh
4   Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, United States
12   Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, United States
› Institutsangaben

Funding K.E.T. was supported in part by the National Heart, Lung, and Blood Institute (grant nos.: K12HL137862 and 1K23HL161352).
Preview

Abstract

Objectives In a randomized controlled trial, we found that applying implementation science (IS) methods and best practices in clinical decision support (CDS) design to create a locally customized, “enhanced” CDS significantly improved evidence-based prescribing of β blockers (BB) for heart failure compared with an unmodified commercially available CDS. At trial conclusion, the enhanced CDS was expanded to all sites. The purpose of this study was to evaluate the real-world sustained effect of the enhanced CDS compared with the commercial CDS.

Methods In this natural experiment of 28 primary care clinics, we compared clinics exposed to the commercial CDS (preperiod) to clinics exposed to the enhanced CDS (both periods). The primary effectiveness outcome was the proportion of alerts resulting in a BB prescription. Secondary outcomes included patient reach and clinician adoption (dismissals).

Results There were 367 alerts for 183 unique patients and 171 unique clinicians (pre: March 2019–August 2019; post: October 2019–March 2020). The enhanced CDS increased prescribing by 26.1% compared with the commercial (95% confidence interval [CI]: 17.0–35.1%), which is consistent with the 24% increase in the previous study. The odds of adopting the enhanced CDS was 81% compared with 29% with the commercial (odds ratio: 4.17, 95% CI: 1.96–8.85). The enhanced CDS adoption and effectiveness rates were 62 and 14% in the preperiod and 92 and 10% in the postperiod.

Conclusion Applying IS methods with CDS best practices was associated with improved and sustained clinician adoption and effectiveness compared with a commercially available CDS tool.

Protection of Human and Animal Subjects

The study was reviewed by the Institutional Review Board and deemed exempt and a full waiver of Health Insurance Portability and Accountability Act authorization was approved.




Publikationsverlauf

Eingereicht: 05. Mai 2023

Angenommen: 02. August 2023

Artikel online veröffentlicht:
18. Oktober 2023

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