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Abstract
OBJECTIVES This literature review summarizes relevant studies from the last three years (2020-2022) related to clinical decision support (CDS) and CDS impact on health disparities and the digital divide. This survey identifies current trends and synthesizes evidence-based recommendations and considerations for future development and implementation of CDS tools. METHODS We conducted a search in PubMed for literature published between 2020 and 2022. Our search strategy was constructed as a combination of the MEDLINE®/PubMed® Health Disparities and Minority Health Search Strategy and relevant CDS MeSH terms and phrases. We then extracted relevant data from the studies, including priority population when applicable, domain of influence on the disparity being addressed, and the type of CDS being used. We also made note of when a study discussed the digital divide in some capacity and organized the comments into general themes through group discussion. RESULTS Our search yielded 520 studies, with 45 included at the conclusion of screening. The most frequent CDS type in this review was point-of-care alerts/reminders (33.3%). Health Care System was the most frequent domain of influence (71.1%), and Blacks/African Americans were the most frequently included priority population (42.2%). Throughout the literature, we found four general themes related to the technology divide: inaccessibility of technology, access to care, trust of technology, and technology literacy.This survey revealed the diversity of CDS being used to address health disparities and several barriers which may make CDS less effective or potentially harmful to certain populations. Regular examinations of literature that feature CDS and address health disparities can help to reveal new strategies and patterns for improving healthcare.
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Affiliation(s)
- Brian J. Douthit
- Post-Doctoral Research Fellow: United States Department of Veterans Affairs, Vanderbilt University, Nashville, TN, USA
| | - Allison B. McCoy
- Assistant Professor: Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
- Director: Clinical Informatics Core, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott D. Nelson
- Associate Professor: Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
- Program Director: MS in Applied Clinical Informatics Program (MS-ACI), Vanderbilt University, Nashville, TN, USA
- Clinical Director: HealthIT, Vanderbilt University Medical Center, Nashville, TN, USA
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Wieben AM, Walden RL, Alreshidi BG, Brown SF, Cato K, Coviak CP, Cruz C, D'Agostino F, Douthit BJ, Forbes TH, Gao G, Johnson SG, Lee MA, Mullen-Fortino M, Park JI, Park S, Pruinelli L, Reger A, Role J, Sileo M, Schultz MA, Vyas P, Jeffery AD. Data Science Implementation Trends in Nursing Practice: A Review of the 2021 Literature. Appl Clin Inform 2023; 14:585-593. [PMID: 37150179 PMCID: PMC10411069 DOI: 10.1055/a-2088-2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/03/2023] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVES The goal of this work was to provide a review of the implementation of data science-driven applications focused on structural or outcome-related nurse-sensitive indicators in the literature in 2021. By conducting this review, we aim to inform readers of trends in the nursing indicators being addressed, the patient populations and settings of focus, and lessons and challenges identified during the implementation of these tools. METHODS We conducted a rigorous descriptive review of the literature to identify relevant research published in 2021. We extracted data on model development, implementation-related strategies and measures, lessons learned, and challenges and stakeholder involvement. We also assessed whether reports of data science application implementations currently follow the guidelines of the Developmental and Exploratory Clinical Investigations of DEcision support systems driven by AI (DECIDE-AI) framework. RESULTS Of 4,943 articles found in PubMed (NLM) and CINAHL (EBSCOhost), 11 were included in the final review and data extraction. Systems leveraging data science were developed for adult patient populations and were primarily deployed in hospital settings. The clinical domains targeted included mortality/deterioration, utilization/resource allocation, and hospital-acquired infections/COVID-19. The composition of development teams and types of stakeholders involved varied. Research teams more frequently reported on implementation methods than implementation results. Most studies provided lessons learned that could help inform future implementations of data science systems in health care. CONCLUSION In 2021, very few studies report on the implementation of data science-driven applications focused on structural- or outcome-related nurse-sensitive indicators. This gap in the sharing of implementation strategies needs to be addressed in order for these systems to be successfully adopted in health care settings.
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Affiliation(s)
- Ann M. Wieben
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, United States
| | - Rachel Lane Walden
- Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University, Nashville, Tennessee, United States
| | - Bader G. Alreshidi
- Medical-Surgical Nursing Department, College of Nursing, University of Hail, Hail, Saudi Arabia
| | | | - Kenrick Cato
- Department of Emergency Medicine, Columbia University School of Nursing, New York, New York, United States
| | - Cynthia Peltier Coviak
- Kirkhof College of Nursing, Grand Valley State University, Allendale, Michigan, United States
| | - Christopher Cruz
- Global Health Technology and Informatics, Chevron, San Ramon, California, United States
| | - Fabio D'Agostino
- Department of Medicine and Surgery, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Brian J. Douthit
- Department of Biomedical Informatics, United States Department of Veterans Affairs, Vanderbilt University, Nashville, Tennessee, United States
| | - Thompson H. Forbes
- Department of Advanced Nursing Practice and Education, East Carolina University College of Nursing, Greenville, North Carolina, United States
| | - Grace Gao
- Atlanta VA Quality Scholars Program, Joseph Maxwell Cleland, Atlanta VA Medical Center, North Druid Hills, Georgia, United States
| | - Steve G. Johnson
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
| | | | | | - Jung In Park
- Sue and Bill Gross School of Nursing, University of California, Irvine, United States
| | - Suhyun Park
- College of Nursing and College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Lisiane Pruinelli
- College of Nursing and College of Medicine, University of Florida, Gainesville, Florida, United States
| | | | - Jethrone Role
- Loma Linda University Health, Loma Linda, California, United States
| | - Marisa Sileo
- Boston Children's Hospital, Boston, Massachusetts, United States
| | | | - Pankaj Vyas
- University of Arizona College of Nursing, Tucson, Arizona, United States
| | - Alvin D. Jeffery
- U.S. Department of Veterans Affairs, Vanderbilt University School of Nursing, Tennessee Valley Healthcare System, Nashville, Tennessee, United States
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3
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Douthit BJ, Walden RL, Cato K, Coviak CP, Cruz C, D'Agostino F, Forbes T, Gao G, Kapetanovic TA, Lee MA, Pruinelli L, Schultz MA, Wieben A, Jeffery AD. Data Science Trends Relevant to Nursing Practice: A Rapid Review of the 2020 Literature. Appl Clin Inform 2022; 13:161-179. [PMID: 35139564 PMCID: PMC8828453 DOI: 10.1055/s-0041-1742218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The term "data science" encompasses several methods, many of which are considered cutting edge and are being used to influence care processes across the world. Nursing is an applied science and a key discipline in health care systems in both clinical and administrative areas, making the profession increasingly influenced by the latest advances in data science. The greater informatics community should be aware of current trends regarding the intersection of nursing and data science, as developments in nursing practice have cross-professional implications. OBJECTIVES This study aimed to summarize the latest (calendar year 2020) research and applications of nursing-relevant patient outcomes and clinical processes in the data science literature. METHODS We conducted a rapid review of the literature to identify relevant research published during the year 2020. We explored the following 16 topics: (1) artificial intelligence/machine learning credibility and acceptance, (2) burnout, (3) complex care (outpatient), (4) emergency department visits, (5) falls, (6) health care-acquired infections, (7) health care utilization and costs, (8) hospitalization, (9) in-hospital mortality, (10) length of stay, (11) pain, (12) patient safety, (13) pressure injuries, (14) readmissions, (15) staffing, and (16) unit culture. RESULTS Of 16,589 articles, 244 were included in the review. All topics were represented by literature published in 2020, ranging from 1 article to 59 articles. Numerous contemporary data science methods were represented in the literature including the use of machine learning, neural networks, and natural language processing. CONCLUSION This review provides an overview of the data science trends that were relevant to nursing practice in 2020. Examinations of such literature are important to monitor the status of data science's influence in nursing practice.
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Affiliation(s)
- Brian J. Douthit
- Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Rachel L. Walden
- Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University, Nashville, Tennessee, United States
| | - Kenrick Cato
- Department of Emergency Medicine, Columbia University School of Nursing, New York, New York, United States
| | - Cynthia P. Coviak
- Professor Emerita of Nursing, Grand Valley State University, Allendale, Michigan, United States
| | - Christopher Cruz
- Global Health Technology and Informatics, Chevron, San Ramon, California, United States
| | - Fabio D'Agostino
- Department of Medicine and Surgery, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Thompson Forbes
- College of Nursing, East Carolina University, Greenville, North California, United States
| | - Grace Gao
- Department of Nursing, St Catherine University, Saint Paul, Minnesota, United States
| | - Theresa A. Kapetanovic
- College of Nursing, East Carolina University, Greenville, North California, United States
| | - Mikyoung A. Lee
- College of Nursing, Texas Woman's University, Denton, Texas, United States
| | - Lisiane Pruinelli
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States
| | - Mary A. Schultz
- Department of Nursing, California State University, San Bernardino, California, United States
| | - Ann Wieben
- School of Nursing, University of Wisconsin-Madison, Wisconsin, United States
| | - Alvin D. Jeffery
- School of Nursing, Vanderbilt University; Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, United States,Address for correspondence Alvin D. Jeffery, PhD, RN-BC, CCRN-K, FNP-BC 461 21st Avenue South, Nashville, TN 37240United States
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Richesson RL, Marsolo KS, Douthit BJ, Staman K, Ho PM, Dailey D, Boyd AD, McTigue KM, Ezenwa MO, Schlaeger JM, Patil CL, Faurot KR, Tuzzio L, Larson EB, O'Brien EC, Zigler CK, Lakin JR, Pressman AR, Braciszewski JM, Grudzen C, Fiol GD. Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory. J Am Med Inform Assoc 2021; 28:2626-2640. [PMID: 34597383 PMCID: PMC8633608 DOI: 10.1093/jamia/ocab202] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/05/2021] [Accepted: 09/02/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE We identified challenges and solutions to using electronic health record (EHR) systems for the design and conduct of pragmatic research. MATERIALS AND METHODS Since 2012, the Health Care Systems Research Collaboratory has served as the resource coordinating center for 21 pragmatic clinical trial demonstration projects. The EHR Core working group invited these demonstration projects to complete a written semistructured survey and used an inductive approach to review responses and identify EHR-related challenges and suggested EHR enhancements. RESULTS We received survey responses from 20 projects and identified 21 challenges that fell into 6 broad themes: (1) inadequate collection of patient-reported outcome data, (2) lack of structured data collection, (3) data standardization, (4) resources to support customization of EHRs, (5) difficulties aggregating data across sites, and (6) accessing EHR data. DISCUSSION Based on these findings, we formulated 6 prerequisites for PCTs that would enable the conduct of pragmatic research: (1) integrate the collection of patient-centered data into EHR systems, (2) facilitate structured research data collection by leveraging standard EHR functions, usable interfaces, and standard workflows, (3) support the creation of high-quality research data by using standards, (4) ensure adequate IT staff to support embedded research, (5) create aggregate, multidata type resources for multisite trials, and (6) create re-usable and automated queries. CONCLUSION We are hopeful our collection of specific EHR challenges and research needs will drive health system leaders, policymakers, and EHR designers to support these suggestions to improve our national capacity for generating real-world evidence.
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Affiliation(s)
- Rachel L Richesson
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Keith S Marsolo
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian J Douthit
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,US Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Karen Staman
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - P Michael Ho
- Department of Medicine, University of Colorado Medicine, Denver, Colorado, USA
| | - Dana Dailey
- Center for Health Sciences, St. Ambrose University, Davenport, Iowa and Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Andrew D Boyd
- Department of Biomedical and Health Information Sciences University of Illinois Chicago, Chicago, Illinois, USA
| | - Kathleen M McTigue
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, University of Florida, College of Nursing, Gainesville, Florida, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois, USA
| | - Crystal L Patil
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois, USA
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina K Zigler
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joshua R Lakin
- Palliative Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alice R Pressman
- Center for Health Systems Research, Sutter Health Center for Health Systems Research, Walnut Creek, California, USA
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
| | - Corita Grudzen
- Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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Douthit BJ, Staes CJ, Del Fiol G, Richesson RL. A thematic analysis to examine the feasibility of EHR-based clinical decision support for implementing Choosing Wisely ® guidelines. JAMIA Open 2021; 4:ooab031. [PMID: 34142016 PMCID: PMC8206400 DOI: 10.1093/jamiaopen/ooab031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/04/2021] [Accepted: 04/15/2021] [Indexed: 11/14/2022] Open
Abstract
Objective To identify important barriers and facilitators relating to the feasibility of implementing clinical practice guidelines (CPGs) as clinical decision support (CDS). Materials and Methods We conducted a qualitative, thematic analysis of interviews from seven interviews with dyads (one clinical expert and one systems analyst) who discussed the feasibility of implementing 10 Choosing Wisely® guidelines at their institutions. We conducted a content analysis to extract salient themes describing facilitators, challenges, and other feasibility considerations regarding implementing CPGs as CDS. Results We identified five themes: concern about data quality impacts implementation planning; the availability of data in a computable format is a primary factor for implementation feasibility; customized strategies are needed to mitigate uncertainty and ambiguity when translating CPGs to an electronic health record-based tool; misalignment of expected CDS with pre-existing clinical workflows impact implementation; and individual level factors of end-users must be considered when selecting and implementing CDS tools. Discussion The themes reveal several considerations for CPG as CDS implementations regarding data quality, knowledge representation, and sociotechnical issues. Guideline authors should be aware that using CDS to implement CPGs is becoming increasingly popular and should consider providing clear guidelines to aid implementation. The complex nature of CPG as CDS implementation necessitates a unified effort to overcome these challenges. Conclusion Our analysis highlights the importance of cooperation and co-development of standards, strategies, and infrastructure to address the difficulties of implementing CPGs as CDS. The complex interactions between the concepts revealed in the interviews necessitates the need that such work should not be conducted in silos. We also implore that implementers disseminate their experiences.
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Affiliation(s)
- Brian J Douthit
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Catherine J Staes
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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Schultz MA, Walden RL, Cato K, Coviak CP, Cruz C, D'Agostino F, Douthit BJ, Forbes T, Gao G, Lee MA, Lekan D, Wieben A, Jeffery AD. Data Science Methods for Nursing-Relevant Patient Outcomes and Clinical Processes: The 2019 Literature Year in Review. Comput Inform Nurs 2021; 39:654-667. [PMID: 34747890 PMCID: PMC8578863 DOI: 10.1097/cin.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data science continues to be recognized and used within healthcare due to the increased availability of large data sets and advanced analytics. It can be challenging for nurse leaders to remain apprised of this rapidly changing landscape. In this article, we describe our findings from a scoping literature review of papers published in 2019 that use data science to explore, explain, and/or predict 15 phenomena of interest to nurses. Fourteen of the 15 phenomena were associated with at least one paper published in 2019. We identified the use of many contemporary data science methods (eg, natural language processing, neural networks) for many of the outcomes. We found many studies exploring Readmissions and Pressure Injuries. The topics of Artificial Intelligence/Machine Learning Acceptance, Burnout, Patient Safety, and Unit Culture were poorly represented. We hope that the studies described in this article help readers: (1) understand the breadth and depth of data science's ability to improve clinical processes and patient outcomes that are relevant to nurses and (2) identify gaps in the literature that are in need of exploration.
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Affiliation(s)
- Mary Anne Schultz
- Author Affiliations: California State University (Dr Schultz); Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University (Ms Walden); Department of Emergency Medicine, Columbia University School of Nursing (Dr Cato); Grand Valley State University (Dr Coviak); Global Health Technology & Informatics, Chevron, San Ramon, CA (Mr Cruz); Saint Camillus International University of Health Sciences, Rome, Italy (Dr D'Agostino); Duke University School of Nursing (Mr Douthit); East Carolina University College of Nursing (Dr Forbes); St Catherine University Department of Nursing (Dr Gao); Texas Woman's University College of Nursing (Dr Lee); Assistant Professor, University of North Carolina at Greensboro School of Nursing (Dr Lekan); University of Wisconsin School of Nursing (Ms Wieben); and Vanderbilt University School of Nursing, and Tennessee Valley Healthcare System, US Department of Veterans Affairs (Dr Jeffery)
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Douthit BJ, Del Fiol G, Staes CJ, Docherty SL, Richesson RL. A Conceptual Framework of Data Readiness: The Contextual Intersection of Quality, Availability, Interoperability, and Provenance. Appl Clin Inform 2021; 12:675-685. [PMID: 34289504 PMCID: PMC8294946 DOI: 10.1055/s-0041-1732423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Data readiness is a concept often used when referring to health information technology applications in the informatics disciplines, but it is not clearly defined in the literature. To avoid misinterpretations in research and implementation, a formal definition should be developed. OBJECTIVES The objective of this research is to provide a conceptual definition and framework for the term data readiness that can be used to guide research and development related to data-based applications in health care. METHODS PubMed, the National Institutes of Health RePORTER, Scopus, the Cochrane Library, and Duke University Library databases for business and information sciences were queried for formal mentions of the term "data readiness." Manuscripts found in the search were reviewed, and relevant information was extracted, evaluated, and assimilated into a framework for data readiness. RESULTS Of the 264 manuscripts found in the database searches, 20 were included in the final synthesis to define data readiness. In these 20 manuscripts, the term data readiness was revealed to encompass the constructs of data quality, data availability, interoperability, and data provenance. DISCUSSION Based upon our review of the literature, we define data readiness as the application-specific intersection of data quality, data availability, interoperability, and data provenance. While these concepts are not new, the combination of these factors in a novel data readiness model may help guide future informatics research and implementation science. CONCLUSION This analysis provides a definition to guide research and development related to data-based applications in health care. Future work should be done to validate this definition, and to apply the components of data readiness to real-world applications so that specific metrics may be developed and disseminated.
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Affiliation(s)
- Brian J Douthit
- School of Nursing, Duke University, Durham, North Carolina, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Catherine J Staes
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
- College of Nursing, University of Utah, Salt Lake City, Utah, United States
| | - Sharron L Docherty
- School of Nursing, Duke University, Durham, North Carolina, United States
- School of Medicine, Duke University, Durham, North Carolina, United States
| | - Rachel L Richesson
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States
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Richesson RL, Staes CJ, Douthit BJ, Thoureen T, Hatch DJ, Kawamoto K, Del Fiol G. Measuring implementation feasibility of clinical decision support alerts for clinical practice recommendations. J Am Med Inform Assoc 2021; 27:514-521. [PMID: 32027357 DOI: 10.1093/jamia/ocz225] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The study sought to describe key features of clinical concepts and data required to implement clinical practice recommendations as clinical decision support (CDS) tools in electronic health record systems and to identify recommendation features that predict feasibility of implementation. MATERIALS AND METHODS Using semistructured interviews, CDS implementers and clinician subject matter experts from 7 academic medical centers rated the feasibility of implementing 10 American College of Emergency Physicians Choosing Wisely Recommendations as electronic health record-embedded CDS and estimated the need for additional data collection. Ratings were combined with objective features of the guidelines to develop a predictive model for technical implementation feasibility. RESULTS A linear mixed model showed that the need for new data collection was predictive of lower implementation feasibility. The number of clinical concepts in each recommendation, need for historical data, and ambiguity of clinical concepts were not predictive of implementation feasibility. CONCLUSIONS The availability of data and need for additional data collection are essential to assess the feasibility of CDS implementation. Authors of practice recommendations and guidelines can enable organizations to more rapidly assess data availability and feasibility of implementation by including operational definitions for required data.
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Affiliation(s)
| | - Catherine J Staes
- University of Utah College of Nursing, Salt Lake City, Utah.,Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, Utah
| | | | - Traci Thoureen
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Hatch
- Duke University School of Nursing, Durham, North Carolina
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, Utah
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Cary MP, Zhuang F, Draelos RL, Pan W, Amarasekara S, Douthit BJ, Kang Y, Colón-Emeric CS. Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture. J Am Med Dir Assoc 2021; 22:291-296. [PMID: 33132014 PMCID: PMC7867606 DOI: 10.1016/j.jamda.2020.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65 years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs). DESIGN Retrospective design/cohort analysis of Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility-Patient Assessment Instrument data. SETTING AND PARTICIPANTS A total of 17,140 persons admitted to Medicare-certified IRFs in 2015 following hospitalization for hip fracture. MEASURES Patient characteristics include sociodemographic (age, gender, race, and social support) and clinical factors (functional status at admission, chronic conditions) and IRF length of stay. Outcomes were 30-day and 1-year all-cause mortality. We trained and evaluated 2 classification models, logistic regression and a multilayer perceptron (MLP), to predict the probability of 30-day and 1-year mortality and evaluated the calibration, discrimination, and precision of the models. RESULTS For 30-day mortality, MLP performed well [acc = 0.74, area under the receiver operating characteristic curve (AUROC) = 0.76, avg prec = 0.10, slope = 1.14] as did logistic regression (acc = 0.78, AUROC = 0.76, avg prec = 0.09, slope = 1.20). For 1-year mortality, the performances were similar for both MLP (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.96) and logistic regression (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.95). CONCLUSION AND IMPLICATIONS A scoring system based on logistic regression may be more feasible to run in current electronic medical records. But MLP models may reduce cognitive burden and increase ability to calibrate to local data, yielding clinical specificity in mortality prediction so that palliative care resources may be allocated more effectively.
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Affiliation(s)
- Michael P Cary
- School of Nursing, Duke University, Durham, NC, USA; Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.
| | - Farica Zhuang
- Department of Computer Science, Duke University, Durham, NC, USA
| | - Rachel Lea Draelos
- Department of Computer Science, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA
| | - Wei Pan
- School of Nursing, Duke University, Durham, NC, USA
| | | | | | - Yunah Kang
- School of Nursing, Duke University, Durham, NC, USA
| | - Cathleen S Colón-Emeric
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA; Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
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Douthit BJ, Richesson R. Applied Interdisciplinary Theory in Health Informatics: A Book Review. Comput Inform Nurs 2021; 39:7-8. [PMID: 37729863 DOI: 10.1097/cin.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Douthit BJ. The influence of the learning health system to address the COVID-19 pandemic: An examination of early literature. Int J Health Plann Manage 2020; 36:244-251. [PMID: 33103264 DOI: 10.1002/hpm.3088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has demanded immediate response from healthcare systems around the world. The learning health system (LHS) was created with rapid uptake of the newest evidence in mind, making it essential in the face of a pandemic. The goal of this review is to gain knowledge on the initial impact of the LHS on addressing the COVID-19 pandemic. METHODS PubMed, Scopus and the Duke University library search tool were used to identify current literature regarding the intersection of the LHS and the COIVD-19 pandemic. Articles were reviewed for their purpose, findings and relation to each component of the LHS. RESULTS Twelve articles were included in the review. All stages of the LHS were addressed from this sample. Most articles addressed some component of interoperability. Articles that interpreted data unique to COVID-19 and demonstrated specific tools and interventions were least common. CONCLUSIONS Gaps in interoperability are well known and unlikely to be solved in the coming months. Collaboration between health systems, researchers, governments and professional societies is needed to support a robust LHS which grants the ability to rapidly adapt to global emergencies.
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Affiliation(s)
- Brian J Douthit
- School of Nursing, Duke University, Durham, North Carolina, USA
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Douthit BJ, Musser RC, Lytle KS, Richesson RL. A Closer Look at the "Right" Format for Clinical Decision Support: Methods for Evaluating a Storyboard BestPractice Advisory. J Pers Med 2020; 10:jpm10040142. [PMID: 32977564 PMCID: PMC7712422 DOI: 10.3390/jpm10040142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 01/17/2023] Open
Abstract
(1) Background: The five rights of clinical decision support (CDS) are a well-known framework for planning the nuances of CDS, but recent advancements have given us more options to modify the format of the alert. One-size-fits-all assessments fail to capture the nuance of different BestPractice Advisory (BPA) formats. To demonstrate a tailored evaluation methodology, we assessed a BPA after implementation of Storyboard for changes in alert fatigue, behavior influence, and task completion; (2) Methods: Data from 19 weeks before and after implementation were used to evaluate differences in each domain. Individual clinics were evaluated for task completion and compared for changes pre- and post-redesign; (3) Results: The change in format was correlated with an increase in alert fatigue, a decrease in erroneous free text answers, and worsened task completion at a system level. At a local level, however, 14% of clinics had improved task completion; (4) Conclusions: While the change in BPA format was correlated with decreased performance, the changes may have been driven primarily by the COVID-19 pandemic. The framework and metrics proposed can be used in future studies to assess the impact of new CDS formats. Although the changes in this study seemed undesirable in aggregate, some positive changes were observed at the level of individual clinics. Personalized implementations of CDS tools based on local need should be considered.
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Affiliation(s)
- Brian J. Douthit
- School of Nursing, Duke University, Durham, NC 27710, USA;
- Correspondence:
| | - R. Clayton Musser
- School of Medicine, Duke University, Durham, NC 27710, USA;
- Duke Health, Duke School of Medicine, Durham, NC 27710 USA;
| | - Kay S. Lytle
- Duke Health, Duke School of Medicine, Durham, NC 27710 USA;
| | - Rachel L. Richesson
- School of Nursing, Duke University, Durham, NC 27710, USA;
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27710, USA
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Douthit BJ, Richesson RL. Emergency Department Clinician Perspectives on the Data Availability to Implement Clinical Decision Support Tools for Five Clinical Practice Guidelines. AMIA Jt Summits Transl Sci Proc 2018; 2017:340-348. [PMID: 29888092 PMCID: PMC5961800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical practice guidelines (CPGs) often serve as the knowledge base for clinical decision support (CDS). While CPGs are rigorously created by medical professional societies, the concepts in each guideline may not be sufficient for translation into CDS applications. In addition, clinicians' perceptions of these concepts may differ greatly, affecting the implementation and impact of CDS within an organization. Five guidelines developed by the American College of Emergency Physicians were systematically explored, generating fifty-one unique clinical concepts. These concepts were presented to two nurses and two physicians, whom were asked to assess and comment on the capture of each clinical concept in the electronic health record (EHR) and the subsequent availability of the data for CDS. Nurses and physicians showed differing perceptions of data availability. These differing perceptions may influence an organizational approach to developing and implementing CDS, potentially informing our understanding of why CDS may not achieve the intended impact.
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