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
Hauptverfasser: 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.
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container_end_page 269
container_issue 1
container_start_page 262
container_title The Journal of rural health
container_volume 38
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
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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 &lt; .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 &lt; .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. 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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 &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; 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 &lt; .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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