Effect of an Automated Patient Dashboard Using Active Choice and Peer Comparison Performance Feedback to Physicians on Statin Prescribing

Patel, Mitesh S.; Kurtzman, Gregory W.; Kannan, S.; Small, Dylan S.; Morris, Alexander; Honeywell, Steve; Leri, Damien; Rareshide, Charles A. L.; Day, Susan; Mahoney, Kevin; Volpp, Kevin G.; Asch, David A.

doi:10.1001/jamanetworkopen.2018.0818

Cited by 88 publications

(133 citation statements)

References 34 publications

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“…A previous systematic review found that the use of structured referral forms and the involvement of consultants in educational activities, both techniques employed here, improved referral appropriateness 24. More recent trials have found that the use of performance feedback methods, including peer comparison with active choice framing and audit and feedback reporting, as well as accountable justification, increased appropriate prescribing behaviour in primary care 25–27. The knowledge translation strategies employed here were primarily passive and may have been less effective than more active strategies 28 29.…”

Section: Discussionmentioning

confidence: 81%

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

et al. 2020

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ObjectivesChronic kidney disease (CKD) is common; therefore, coordination of care between primary care and nephrology is important. Ontario Renal Network’s KidneyWise toolkit was developed to provide guidance on the detection and management of people with CKD in primary care (www.kidneywise.ca). The aim of this study was to evaluate the impact of the April 2015 KidneyWise toolkit release on the characteristics of primary care referrals to nephrology.Design and settingThe study was a prospective pre-post design conducted at two nephrology sites (community site: Trillium Health Partners in Mississauga, Ontario, Canada, and academic site: St Joseph’s Healthcare in Hamilton, Ontario, Canada). Referrals were compared during the 3-month time period immediately prior to, and during a 3-month period 1 year after, the toolkit release.Primary and secondary outcome measuresThe primary outcome was the change in proportion of referrals for CKD that met the KidneyWise criteria. Additional secondary referral and quality of care outcomes were also evaluated. Multivariable logistic regression was used to evaluate preselected variables for their independent association with referrals that met the KidneyWise criteria.ResultsThe proportion of referrals for CKD among people who met the KidneyWise referral criteria did not significantly change from pre-KidneyWise to post-KidneyWise implementation (44.7% vs 45.8%, respectively, adjusted OR 1.16, 95% CI 0.85 to 1.59, p=0.36). The proportion of referrals for CKD that provided a urine albumin-creatinine ratio significantly increased post-KidneyWise (25.8% vs 43.8%, adjusted OR 1.45, 95% CI 1.06 to 1.97, p=0.02). The significant independent predictors of meeting the KidneyWise referral criteria were academic site, increased age and use of the KidneyWise referral form.ConclusionsWe did not observe any change in the proportion of appropriate referrals for CKD at two large nephrology centres 1 year after implementation of the KidneyWise toolkit.

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Section: Discussionmentioning

confidence: 81%

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

et al. 2020

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“…It should also be emphasized that the time involved in performing a consultation is independent of the quality of medical care provided, and while our study focused on the effect of the dashboard on consult TAT, this was not a guideline-based outcome that might accurately reflect quality of care, such as that studied in the PRESCRIBE cluster-randomized controlled trial. 41 Despite these limitations, we found that a 5-month decrease in inpatient neurological consultation TAT followed the neurological dashboard go-live at a large academic medical center, which persisted over the following 7 months. We cannot definitively conclude that introduction of the iNYP neurology dashboard resulted in reduced TAT, decreases in cognitive burden, or increases in face-to-face time with patients, but we demonstrated that significant numbers of neurological and nonneurological house staff used the dashboard.…”

Section: Limitationsmentioning

confidence: 77%

Neurological Dashboards and Consultation Turnaround Time at an Academic Medical Center

et al. 2019

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Background Neurologists perform a significant amount of consultative work. Aggregative electronic health record (EHR) dashboards may help to reduce consultation turnaround time (TAT) which may reflect time spent interfacing with the EHR. Objectives This study was aimed to measure the difference in TAT before and after the implementation of a neurological dashboard. Methods We retrospectively studied a neurological dashboard in a read-only, web-based, clinical data review platform at an academic medical center that was separate from our institutional EHR. Using our EHR, we identified all distinct initial neurological consultations at our institution that were completed in the 5 months before, 5 months after, and 12 months after the dashboard go-live in December 2017. Using log data, we determined total dashboard users, unique page hits, patient-chart accesses, and user departments at 5 months after go-live. We calculated TAT as the difference in time between the placement of the consultation order and completion of the consultation note in the EHR. Results By April 30th in 2018, we identified 269 unique users, 684 dashboard page hits (median hits/user 1.0, interquartile range [IQR] = 1.0), and 510 unique patient-chart accesses. In 5 months before the go-live, 1,434 neurology consultations were completed with a median TAT of 2.0 hours (IQR = 2.5) which was significantly longer than during 5 months after the go-live, with 1,672 neurology consultations completed with a median TAT of 1.8 hours (IQR = 2.2; p = 0.001). Over the following 7 months, 2,160 consultations were completed and median TAT remained unchanged at 1.8 hours (IQR = 2.5). Conclusion At a large academic institution, we found a significant decrease in inpatient consult TAT 5 and 12 months after the implementation of a neurological dashboard. Further study is necessary to investigate the cognitive and operational effects of aggregative dashboards in neurology and to optimize their use.

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“…BE offers unique insights for the design of implementation strategies that target human decisionmaking constraints (i.e., cognitive heuristics) across settings. BE approaches have yielded notable effects in changing clinician practices in other health domains [29][30][31][32]. For instance, changing the default options in the electronic health record (EHR) has been found to increase the prescribing of generic medications over pricier, brand-name medicines [29].…”

Section: Leveraging Insights From Behavioral Economicsmentioning

confidence: 99%

Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol

Davis

Wolk

Jager‐Hyman

et al. 2020

Pilot Feasibility Stud

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Background Suicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention in two settings where individuals at risk for suicide are especially likely to present: primary care and specialty mental health care. We will leverage methods from behavioral economics, which involves understanding the many factors that influence human decision making, to inform strategy development. Methods We will identify key mechanisms that limit implementation of evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health through contextual inquiry involving behavioral health and primary care clinicians. Second, we will use contextual inquiry results to systematically design a menu of behavioral economics-informed implementation strategies that cut across settings, in collaboration with an advisory board composed of key stakeholders (i.e., behavioral economists, clinicians, implementation scientists, and suicide prevention experts). Finally, we will conduct rapid-cycle trials to test and refine the menu of implementation strategies. Primary outcomes include clinician-reported feasibility and acceptability of the implementation strategies. Discussion Findings will elucidate ways to address common and unique barriers to evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health care. Results will yield refined, pragmatically tested strategies that can inform larger confirmatory trials to combat the growing public health crisis of suicide.

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Effect of an Automated Patient Dashboard Using Active Choice and Peer Comparison Performance Feedback to Physicians on Statin Prescribing

Cited by 88 publications

References 34 publications

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

Neurological Dashboards and Consultation Turnaround Time at an Academic Medical Center

Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol

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