The impact of the implementation of a clinical decision support system on the quality of healthcare services in a primary care setting

Mahmoud, Ahmed Sherif; Alkhenizan, Abdullah; Shafiq, Mohammed; Alsoghayer, Suad

doi:10.4103/jfmpc.jfmpc_1728_20

Cited by 8 publications

(16 citation statements)

References 24 publications

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“…This two-pronged approach was trained on publicly available research data (ADNI) but tested on real-world patients of a memory clinic (CCBH), exhibiting high general clinical utility especially in the 5-minute primary screening stage, and affording the ability to increase screening potential for specialists and clinical researchers in the second stage. As CDS systems become more widely integrated into clinical practice, these types of multi-tiered systems may be highly useful at ensuring those with MCI and mild ADRD are referred for formal diagnosis [20,23]. While each stage can be administered separately, enabling the quicker and simpler assessment stage to be administered in primary care and research screening contexts, a combined approach may provide a robust ability to identify very mild impairment when required.…”

Section: Discussionmentioning

confidence: 99%

Hierarchical Two-Stage Cost-Sensitive Clinical Decision Support System for Screening Prodromal Alzheimer’s Disease and Related Dementias

Kleiman

Ariko

Galvin

2022

Preprint

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Background: The detection of subtle cognitive impairment in a clinical setting is difficult, and because time is a key factor in small clinics and research sites, the brief cognitive assessments that are relied upon often misclassify patients with very mild impairment as normal. In this study, we seek to identify a parsimonious screening tool in one stage, followed by additional assessments in an optional second stage if additional specificity is desired, tested using a machine learning algorithm capable of being integrated into a clinical decision support system. Methods: The best primary stage incorporated measures of short-term memory, executive and visuospatial functioning, and self-reported memory and daily living questions, with a total time of 5 minutes. The best secondary stage incorporated a measure of neurobiology as well as additional cognitive assessment and brief informant report questionnaires, totaling 30 minutes including delayed recall. Combined performance was evaluated using 25 sets of models, trained on 1181 ADNI participants and tested on 127 patients from a memory clinic. Results: The 5-minute primary stage was highly sensitive (96.5%) but lacked specificity (34.1%), with an AUC of 87.5% and DOR of 14.3. The optional secondary stage increased specificity to 58.6%, resulting in an overall AUC of 89.7% using the best model combination of logistic regression for stage 1 and gradient-boosted machine for stage 2. Conclusions: The primary stage is brief and effective at screening, with the optional two-stage technique further increasing specificity. The hierarchical two-stage technique exhibited similar accuracy but with reduced costs compared to the more common single-stage paradigm.

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Section: Discussionmentioning

confidence: 99%

Hierarchical Two-Stage Cost-Sensitive Clinical Decision Support System for Screening Prodromal Alzheimer’s Disease and Related Dementias

Kleiman

Ariko

Galvin

2022

Preprint

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“…The VI could be integrated into clinical decision support systems that examine the EHR and automatically flag patients, enabling seamless integration into clinical practice. 44 Identifying high vulnerability in asymptomatic individuals could improve early-stage screening for primary prevention studies, while mildly symptomatic patients could be targeted for secondary prevention. 6,45 A cutoff score of 8 for determining high/low vulnerability was chosen for our sample due to its balanced sensitivity and specificity in addition to a high diagnostic OR, along with our aim of developing an effective screen for further cognitive testing.…”

Section: Discussionmentioning

confidence: 99%

“…Potential clinical use of the VI could be in identifying patients likely to benefit most from regular cognitive screening procedures and adhering to primary prevention strategies. The VI could be integrated into clinical decision support systems that examine the EHR and automatically flag patients, enabling seamless integration into clinical practice 44 . Identifying high vulnerability in asymptomatic individuals could improve early‐stage screening for primary prevention studies, while mildly symptomatic patients could be targeted for secondary prevention 6,45 …”

Section: Discussionmentioning

confidence: 99%

The Vulnerability Index: A weighted measure of dementia and cognitive impairment risk

Kleiman

Galvin

2021

Alz & Dem Diag Ass & Dis Mo

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Introduction A brief, easily calculated and interpretable index to assess vulnerability to developing cognitive impairment is needed in clinical practice and research. To address this, we developed the Vulnerability Index (VI) with the goal of identifying individuals possessing a high risk for cognitive impairment. Methods Twelve easily obtained sociodemographic, medical, and functional factors were used to develop the VI, with each selectively weighted based on factor analysis and predictive modeling. This cross‐sectional study examined 387 subject‐partner dyads. Results The VI was found to accurately discriminate between cognitively normal controls and participants with cognitive impairment (area under the curve [AUC]: 0.844; 95% confidence interval [CI]: 0.776‐0.913) and individuals scoring high on the VI (≥8) had worse health, functional, behavioral, cognitive, and quality of life ratings than those with lower scores. Discussion The VI could be used in screening asymptomatic individuals for risk of cognitive impairment and guiding the development of primary and secondary prevention plans.

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“…Some aids have been successful in improving quality of care, including one which increased vaccination and cancer screening rates in primary care. 15,16 A decision aid that prompted providers to investigate or manage dementia was shown to increase detection of dementia in primary care. 17 Integrated into an electronic health record (EHR), these aids could prompt the caregiver, clinician, or other members of the care team to collect necessary information, such as cognitive and functional data, and integrate results of the diagnostic testing to provide an objective assessment of the data and assist clinicians with interpretation.…”

Section: Capabilitymentioning

confidence: 99%

A Roadmap for Modifying Clinician Behavior to Improve the Detection of Cognitive Impairment

2022

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A staggering number of individuals live with cognitive decline. Primary care providers are ideally situated to detect the first signs of cognitive decline, but many persons remain undiagnosed. This limits their access to appropriate care. Unfortunately, the timely diagnosis of mild cognitive impairment or dementia in primary care is difficult to achieve. There is a great need for interventions to address this problem. This article applies an implementation science framework, the Behavioral Change Wheel, to evaluate the factors that influence detection of cognitive impairment in primary care and proposes candidate interventions for future study.

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The impact of the implementation of a clinical decision support system on the quality of healthcare services in a primary care setting

Cited by 8 publications

References 24 publications

Hierarchical Two-Stage Cost-Sensitive Clinical Decision Support System for Screening Prodromal Alzheimer’s Disease and Related Dementias

Hierarchical Two-Stage Cost-Sensitive Clinical Decision Support System for Screening Prodromal Alzheimer’s Disease and Related Dementias

The Vulnerability Index: A weighted measure of dementia and cognitive impairment risk

A Roadmap for Modifying Clinician Behavior to Improve the Detection of Cognitive Impairment

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