Deploying an Electronic Clinical Decision Support Tool for Diagnosis and Treatment of Pneumonia Into Rural and Critical Access Hospitals: Utilization, Effect on Processes of Care, and Clinician Satisfaction
Purpose Electronic clinical decision support (CDS) for treatment of community‐acquired pneumonia (ePNa) is associated with improved guideline adherence and decreased mortality. How rural providers respond to CDS developed for urban hospitals could shed light on extending CDS to resource‐limited sett...
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Veröffentlicht in: | The Journal of rural health 2022, Vol.38 (1), p.262-269 |
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container_title | The Journal of rural health |
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creator | Carr, Jason R. Jones, Barbara E. Collingridge, Dave S. Webb, Brandon J. Vines, Caroline Zobell, Blake Allen, Todd L. Srivastava, Rajendu Rubin, Jenna Dean, Nathan C. |
description | Purpose
Electronic clinical decision support (CDS) for treatment of community‐acquired pneumonia (ePNa) is associated with improved guideline adherence and decreased mortality. How rural providers respond to CDS developed for urban hospitals could shed light on extending CDS to resource‐limited settings.
Methods
ePNa was deployed into 10 rural and critical access hospital emergency departments (EDs) in Utah and Idaho in 2018. We reviewed pneumonia cases identified through ICD‐10 codes after local deployment to measure ePNa utilization and guideline adherence. ED providers were surveyed to assess quantitative and qualitative aspects of satisfaction.
Findings
ePNa was used in 109/301 patients with pneumonia (36%, range 0%‐67% across hospitals) and was associated with appropriate antibiotic selection (93% vs 65%, P < .001). Fifty percent of survey recipients responded, 87% were physicians, 87% were men, and the median ED experience was 10 years. Mean satisfaction with ePNa was 3.3 (range 1.7‐4.8) on a 5‐point Likert scale. Providers with a favorable opinion of ePNa were more likely to favor implementation of additional CDS (P = .005). Satisfaction was not associated with provider type, age, years of experience or experience with ePNa. Ninety percent of respondents provided qualitative feedback. The most common theme in high and low utilization hospitals was concern about usability. Compared to high utilization hospitals, low utilization hospitals more frequently identified concerns about adaptation for local needs.
Conclusions
ePNa deployment to rural and critical access EDs was moderately successful and associated with improved antibiotic use. Concerns about usability and adapting ePNa for local use predominated the qualitative feedback. |
doi_str_mv | 10.1111/jrh.12543 |
format | Article |
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Electronic clinical decision support (CDS) for treatment of community‐acquired pneumonia (ePNa) is associated with improved guideline adherence and decreased mortality. How rural providers respond to CDS developed for urban hospitals could shed light on extending CDS to resource‐limited settings.
Methods
ePNa was deployed into 10 rural and critical access hospital emergency departments (EDs) in Utah and Idaho in 2018. We reviewed pneumonia cases identified through ICD‐10 codes after local deployment to measure ePNa utilization and guideline adherence. ED providers were surveyed to assess quantitative and qualitative aspects of satisfaction.
Findings
ePNa was used in 109/301 patients with pneumonia (36%, range 0%‐67% across hospitals) and was associated with appropriate antibiotic selection (93% vs 65%, P < .001). Fifty percent of survey recipients responded, 87% were physicians, 87% were men, and the median ED experience was 10 years. Mean satisfaction with ePNa was 3.3 (range 1.7‐4.8) on a 5‐point Likert scale. Providers with a favorable opinion of ePNa were more likely to favor implementation of additional CDS (P = .005). Satisfaction was not associated with provider type, age, years of experience or experience with ePNa. Ninety percent of respondents provided qualitative feedback. The most common theme in high and low utilization hospitals was concern about usability. Compared to high utilization hospitals, low utilization hospitals more frequently identified concerns about adaptation for local needs.
Conclusions
ePNa deployment to rural and critical access EDs was moderately successful and associated with improved antibiotic use. Concerns about usability and adapting ePNa for local use predominated the qualitative feedback.</description><identifier>ISSN: 0890-765X</identifier><identifier>EISSN: 1748-0361</identifier><identifier>DOI: 10.1111/jrh.12543</identifier><identifier>PMID: 33244803</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Access ; Antibiotics ; care process ; Clinical decision making ; Computerized decision support systems ; decision support ; Decision support systems ; Decision Support Systems, Clinical ; Deployment ; Electronics ; emergency department ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital ; Feedback ; Health services ; Hospitals ; Hospitals, Urban ; Humans ; Male ; Medical diagnosis ; Medical treatment ; Personal Satisfaction ; Physicians ; Pneumonia ; Pneumonia - diagnosis ; Pneumonia - drug therapy ; Respondents ; Rural health care ; Satisfaction ; Usability ; Utilization</subject><ispartof>The Journal of rural health, 2022, Vol.38 (1), p.262-269</ispartof><rights>2020 National Rural Health Association</rights><rights>2020 National Rural Health Association.</rights><rights>2022 National Rural Health Association</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4433-5c2ba1972ed5f98e5af48d24928311b88733e61560c3dac2fb5ff85e81e959eb3</citedby><cites>FETCH-LOGICAL-c4433-5c2ba1972ed5f98e5af48d24928311b88733e61560c3dac2fb5ff85e81e959eb3</cites><orcidid>0000-0001-9821-8224</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjrh.12543$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjrh.12543$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,315,781,785,886,1418,27871,27929,27930,31004,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33244803$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carr, Jason R.</creatorcontrib><creatorcontrib>Jones, Barbara E.</creatorcontrib><creatorcontrib>Collingridge, Dave S.</creatorcontrib><creatorcontrib>Webb, Brandon J.</creatorcontrib><creatorcontrib>Vines, Caroline</creatorcontrib><creatorcontrib>Zobell, Blake</creatorcontrib><creatorcontrib>Allen, Todd L.</creatorcontrib><creatorcontrib>Srivastava, Rajendu</creatorcontrib><creatorcontrib>Rubin, Jenna</creatorcontrib><creatorcontrib>Dean, Nathan C.</creatorcontrib><title>Deploying an Electronic Clinical Decision Support Tool for Diagnosis and Treatment of Pneumonia Into Rural and Critical Access Hospitals: Utilization, Effect on Processes of Care, and Clinician Satisfaction</title><title>The Journal of rural health</title><addtitle>J Rural Health</addtitle><description>Purpose
Electronic clinical decision support (CDS) for treatment of community‐acquired pneumonia (ePNa) is associated with improved guideline adherence and decreased mortality. How rural providers respond to CDS developed for urban hospitals could shed light on extending CDS to resource‐limited settings.
Methods
ePNa was deployed into 10 rural and critical access hospital emergency departments (EDs) in Utah and Idaho in 2018. We reviewed pneumonia cases identified through ICD‐10 codes after local deployment to measure ePNa utilization and guideline adherence. ED providers were surveyed to assess quantitative and qualitative aspects of satisfaction.
Findings
ePNa was used in 109/301 patients with pneumonia (36%, range 0%‐67% across hospitals) and was associated with appropriate antibiotic selection (93% vs 65%, P < .001). Fifty percent of survey recipients responded, 87% were physicians, 87% were men, and the median ED experience was 10 years. Mean satisfaction with ePNa was 3.3 (range 1.7‐4.8) on a 5‐point Likert scale. Providers with a favorable opinion of ePNa were more likely to favor implementation of additional CDS (P = .005). Satisfaction was not associated with provider type, age, years of experience or experience with ePNa. Ninety percent of respondents provided qualitative feedback. The most common theme in high and low utilization hospitals was concern about usability. Compared to high utilization hospitals, low utilization hospitals more frequently identified concerns about adaptation for local needs.
Conclusions
ePNa deployment to rural and critical access EDs was moderately successful and associated with improved antibiotic use. Concerns about usability and adapting ePNa for local use predominated the qualitative feedback.</description><subject>Access</subject><subject>Antibiotics</subject><subject>care process</subject><subject>Clinical decision making</subject><subject>Computerized decision support systems</subject><subject>decision support</subject><subject>Decision support systems</subject><subject>Decision Support Systems, Clinical</subject><subject>Deployment</subject><subject>Electronics</subject><subject>emergency department</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital</subject><subject>Feedback</subject><subject>Health services</subject><subject>Hospitals</subject><subject>Hospitals, Urban</subject><subject>Humans</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical treatment</subject><subject>Personal Satisfaction</subject><subject>Physicians</subject><subject>Pneumonia</subject><subject>Pneumonia - diagnosis</subject><subject>Pneumonia - drug therapy</subject><subject>Respondents</subject><subject>Rural health care</subject><subject>Satisfaction</subject><subject>Usability</subject><subject>Utilization</subject><issn>0890-765X</issn><issn>1748-0361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>7TQ</sourceid><recordid>eNp1kc9u1DAQhy0EosvCgRdAljghNW38J1mHA1KVXdiiSlTtVuJmOY699SprB9sBLQ_JM-FsSgUHfJmDv_nmNxoAXqP8DKV3vvP3ZwgXlDwBM7SgLMtJiZ6CWc6qPFuUxdcT8CKEXZ7jihH6HJwQgillOZmBX0vVd-5g7BYKC1edktE7aySsO5OK6OBSSROMs_B26HvnI9w410HtPFwasbUumJBaW7jxSsS9shE6Da-tGvbJI-CljQ7eDD6ZRqr2Jh61F1KqEODahd5E0YX38C6azvwUMc06hSutUxSYxl57N5IqjN5aeHU6iY75TAp9m1qCFnJsfAme6SRTrx7qHNx9XG3qdXb15dNlfXGVSUoJyQqJG4GqBVZtoSumCqEpazGtMCMINYwtCFElKspcklZIrJtCa1YohlRVVKohc_Bh8vZDs1etTGunDXnvzV74A3fC8H9_rLnnW_edM0QrmvRz8PZB4N23QYXId27wNmXmuEQUI1YRmqh3EyW9C8Er_TgB5Xw8PU-n58fTJ_bN35EeyT-3TsD5BPwwnTr838Q_36wn5W_WG70V</recordid><startdate>2022</startdate><enddate>2022</enddate><creator>Carr, Jason R.</creator><creator>Jones, Barbara E.</creator><creator>Collingridge, Dave S.</creator><creator>Webb, Brandon J.</creator><creator>Vines, Caroline</creator><creator>Zobell, Blake</creator><creator>Allen, Todd L.</creator><creator>Srivastava, Rajendu</creator><creator>Rubin, Jenna</creator><creator>Dean, Nathan C.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T2</scope><scope>7TQ</scope><scope>C1K</scope><scope>DHY</scope><scope>DON</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9821-8224</orcidid></search><sort><creationdate>2022</creationdate><title>Deploying an Electronic Clinical Decision Support Tool for Diagnosis and Treatment of Pneumonia Into Rural and Critical Access Hospitals: Utilization, Effect on Processes of Care, and Clinician Satisfaction</title><author>Carr, Jason R. ; Jones, Barbara E. ; Collingridge, Dave S. ; Webb, Brandon J. ; Vines, Caroline ; Zobell, Blake ; Allen, Todd L. ; Srivastava, Rajendu ; Rubin, Jenna ; Dean, Nathan C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4433-5c2ba1972ed5f98e5af48d24928311b88733e61560c3dac2fb5ff85e81e959eb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Access</topic><topic>Antibiotics</topic><topic>care process</topic><topic>Clinical decision making</topic><topic>Computerized decision support systems</topic><topic>decision support</topic><topic>Decision support systems</topic><topic>Decision Support Systems, Clinical</topic><topic>Deployment</topic><topic>Electronics</topic><topic>emergency department</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital</topic><topic>Feedback</topic><topic>Health services</topic><topic>Hospitals</topic><topic>Hospitals, Urban</topic><topic>Humans</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical treatment</topic><topic>Personal Satisfaction</topic><topic>Physicians</topic><topic>Pneumonia</topic><topic>Pneumonia - diagnosis</topic><topic>Pneumonia - drug therapy</topic><topic>Respondents</topic><topic>Rural health care</topic><topic>Satisfaction</topic><topic>Usability</topic><topic>Utilization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carr, Jason R.</creatorcontrib><creatorcontrib>Jones, Barbara E.</creatorcontrib><creatorcontrib>Collingridge, Dave S.</creatorcontrib><creatorcontrib>Webb, Brandon J.</creatorcontrib><creatorcontrib>Vines, Caroline</creatorcontrib><creatorcontrib>Zobell, Blake</creatorcontrib><creatorcontrib>Allen, Todd L.</creatorcontrib><creatorcontrib>Srivastava, Rajendu</creatorcontrib><creatorcontrib>Rubin, Jenna</creatorcontrib><creatorcontrib>Dean, Nathan C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>PAIS Index</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of rural health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carr, Jason R.</au><au>Jones, Barbara E.</au><au>Collingridge, Dave S.</au><au>Webb, Brandon J.</au><au>Vines, Caroline</au><au>Zobell, Blake</au><au>Allen, Todd L.</au><au>Srivastava, Rajendu</au><au>Rubin, Jenna</au><au>Dean, Nathan C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Deploying an Electronic Clinical Decision Support Tool for Diagnosis and Treatment of Pneumonia Into Rural and Critical Access Hospitals: Utilization, Effect on Processes of Care, and Clinician Satisfaction</atitle><jtitle>The Journal of rural health</jtitle><addtitle>J Rural Health</addtitle><date>2022</date><risdate>2022</risdate><volume>38</volume><issue>1</issue><spage>262</spage><epage>269</epage><pages>262-269</pages><issn>0890-765X</issn><eissn>1748-0361</eissn><abstract>Purpose
Electronic clinical decision support (CDS) for treatment of community‐acquired pneumonia (ePNa) is associated with improved guideline adherence and decreased mortality. How rural providers respond to CDS developed for urban hospitals could shed light on extending CDS to resource‐limited settings.
Methods
ePNa was deployed into 10 rural and critical access hospital emergency departments (EDs) in Utah and Idaho in 2018. We reviewed pneumonia cases identified through ICD‐10 codes after local deployment to measure ePNa utilization and guideline adherence. ED providers were surveyed to assess quantitative and qualitative aspects of satisfaction.
Findings
ePNa was used in 109/301 patients with pneumonia (36%, range 0%‐67% across hospitals) and was associated with appropriate antibiotic selection (93% vs 65%, P < .001). Fifty percent of survey recipients responded, 87% were physicians, 87% were men, and the median ED experience was 10 years. Mean satisfaction with ePNa was 3.3 (range 1.7‐4.8) on a 5‐point Likert scale. Providers with a favorable opinion of ePNa were more likely to favor implementation of additional CDS (P = .005). Satisfaction was not associated with provider type, age, years of experience or experience with ePNa. Ninety percent of respondents provided qualitative feedback. The most common theme in high and low utilization hospitals was concern about usability. Compared to high utilization hospitals, low utilization hospitals more frequently identified concerns about adaptation for local needs.
Conclusions
ePNa deployment to rural and critical access EDs was moderately successful and associated with improved antibiotic use. Concerns about usability and adapting ePNa for local use predominated the qualitative feedback.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33244803</pmid><doi>10.1111/jrh.12543</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9821-8224</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Access Antibiotics care process Clinical decision making Computerized decision support systems decision support Decision support systems Decision Support Systems, Clinical Deployment Electronics emergency department Emergency medical care Emergency medical services Emergency Service, Hospital Feedback Health services Hospitals Hospitals, Urban Humans Male Medical diagnosis Medical treatment Personal Satisfaction Physicians Pneumonia Pneumonia - diagnosis Pneumonia - drug therapy Respondents Rural health care Satisfaction Usability Utilization |
title | Deploying an Electronic Clinical Decision Support Tool for Diagnosis and Treatment of Pneumonia Into Rural and Critical Access Hospitals: Utilization, Effect on Processes of Care, and Clinician Satisfaction |
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