Developing a Unit-Based Quality Improvement Program in a Large Neonatal ICU

Dye, Mary; Pugh, Caitlin; Sala, Christa; Scott, Theresa A; Wallace, Tamara; Grubb, Peter H.; Hatch, L. Dupree

doi:10.1016/j.jcjq.2021.06.003

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…Researchers have addressed similar issues for other clinical conditions through platforms and dashboards that synthesize information from the EHR. Visualization dashboards have been used to manage the multiple information streams in intensive care units, where they reduce cognitive load [ 6 ] and improve quality metric adherence [ 7 ], which is variable in neurology [ 8 ]. The time required for an inpatient neurology consultation shortened after implementation of a clinical data review platform that integrated clinical information with vital signs, imaging results, and lab findings [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform

Brown¹,

Schleimer²,

Bledsoe³

et al. 2022

JMIR Hum Factors

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Background People with Parkinson disease (PD) have a variety of complex medical problems that require detailed review at each clinical encounter for appropriate management. Care of other complex conditions has benefited from digital health solutions that efficiently integrate disparate clinical information. Although various digital approaches have been developed for research and care in PD, no digital solution to personalize and improve communication in a clinical encounter is readily available. Objective We intend to improve the efficacy and efficiency of clinical encounters with people with PD through the development of a platform (PD-BRIDGE) with personalized clinical information from the electronic health record (EHR) and patient-reported outcome (PRO) data. Methods Using human-centered design (HCD) processes, we engaged clinician and patient stakeholders in developing PD-BRIDGE through three phases: an inspiration phase involving focus groups and discussions with people having PD, an ideation phase generating preliminary mock-ups for feedback, and an implementation phase testing the platform. To qualitatively evaluate the platform, movement disorders neurologists and people with PD were sent questionnaires asking about the technical validity, usability, and clinical relevance of PD-BRIDGE after their encounter. Results The HCD process led to a platform with 4 modules. Among these, 3 modules that pulled data from the EHR include a longitudinal module showing motor ratings over time, a display module showing the most recently collected clinical rating scales, and another display module showing relevant laboratory values and diagnoses; the fourth module displays motor symptom fluctuation based on an at-home diary. In the implementation phase, PD-BRIDGE was used in 17 clinical encounters for patients cared for by 1 of 11 movement disorders neurologists. Most patients felt that PD-BRIDGE facilitated communication with their clinician (n=14, 83%) and helped them understand their disease trajectory (n=11, 65%) and their clinician’s recommendations (n=11, 65%). Neurologists felt that PD-BRIDGE improved their ability to understand the patients’ disease course (n=13, 75% of encounters), supported clinical care recommendations (n=15, 87%), and helped them communicate with their patients (n=14, 81%). In terms of improvements, neurologists noted that data in PD-BRIDGE were not exhaustive in 62% (n=11) of the encounters. Conclusions Integrating clinically relevant information from EHR and PRO data into a visually efficient platform (PD-BRIDGE) can facilitate clinical encounters with people with PD. Developing new modules with more disparate information could improve these complex encounters even further.

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Section: Introductionmentioning

confidence: 99%

Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform

Brown¹,

Schleimer²,

Bledsoe³

et al. 2022

JMIR Hum Factors

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Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days

Sattler,

Phadke,

Mickelsen

et al. 2023

J GEN INTERN MED

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Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform (Preprint)

Brown¹,

Schleimer²,

Bledsoe³

et al. 2021

Preprint

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BACKGROUND People with Parkinson’s disease (PD) have a variety of complex medical problems that require detailed review at each clinical encounter for appropriate management. Digital health solutions that efficiently integrate and display this information are needed to improve the care for people with PD. OBJECTIVE To improve the efficacy and efficiency of clinical encounters with patients with PD through development of a platform (PD-BRIDGE) with personalized clinical information from both the electronic health record (EHR) and patient-reported outcome data (PROs). METHODS Using Human Centered Design (HCD) processes, we engaged clinician and patient stakeholders in developing PD-BRIDGE through three phases: an inspiration phase involving focus groups and discussions with patients with PD, an ideation phase generating preliminary mockups for feedback, and an implementation phase testing the platform. Movement disorders neurologists and patients with PD were sent surveys asking about the technical validity, usability, and clinical relevance of PD-BRIDGE after their encounter. RESULTS The HCD process led to a platform with four modules: three modules which pulled data from the EHR – (a) a longitudinal module showing motor ratings over time, (b) a display of the most recently collected clinical rating scales, and (c) a display of relevant laboratory values and diagnoses – and (d) one module displaying motor symptom fluctuation based on an at-home diary. In the implementation phase, PD-BRIDGE was used in 17 clinical encounters for patients cared for by one of 11 movement disorders neurologists. Most patients felt that PD-BRIDGE facilitated communication with their clinician (83%) and helped them understand their disease trajectory (65%) and their clinician’s recommendations (65%). Neurologists felt that PD-BRIDGE improved their ability to understand the patient’s disease course (75% of encounters), supported clinical care recommendations (87%), and helped them communicate with their patient (81%). In terms of improvements, neurologists noted that data in PD-BRIDGE were not exhaustive in 62% of encounters. CONCLUSIONS Integrating clinically relevant information from EHR and PRO data into a visually efficient platform (PD-BRIDGE) can facilitate clinical encounters with people with PD. Developing new modules with more disparate information could improve these complex encounters even further.

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Developing a Unit-Based Quality Improvement Program in a Large Neonatal ICU

Cited by 3 publications

References 28 publications

Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform

Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform

Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days

Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform (Preprint)

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