DevelopmentofaProposedAnalyticalFrameworkforPatient-centeredCDS

METHODS

CONCLUSIONS

REFERENCES

RESULTS

INTRODUCTION

ThePatient-CenteredClinicalDecisionSupportLearningNetwork(PCCDSLearningNetwork)isbringingtogetherstakeholderstoaddresstheopportunitiesandchallengesarounddisseminationofevidence-basedfindingsthroughpatient-centeredclinicaldecisionsupport(PCCDS).ItscentralfocusisprovidingaforumforstakeholderstoaddressopportunitiesandchallengesaroundPCCDS.Tothisend,theLearningNetworkhasdevelopedan‘AnalyticFrameworkforAction’tofacilitatethetranslationofevidence(suchasPCORfindings)intoPCCDSforclinicalpractice.

ThePCCDSLearningNetworkispromotingPCCDS,whichsupportscareanddecision-makingforindividualpatientswithinformationregardingPCORfindings,patient-specificdata(e.g.patient-generateddataandpatient-reportedoutcomes)atthepointofcarebetweenapatient,provider,and/orpatientcaregiver.ToexplorethekeyfactorsaffectingPCCDSthroughoutitslifecycle,wedevelopedtheAnalyticalFrameworkforAction(AFA)basedoniterativediscussionswithnumerousstakeholders.TheAFAhasbeenavaluablemeansforidentifyingareasofopportunityandchallengetoPCCDS,aswellasavaluableconceptualtoolforframingdiscussionswithadiversegroupofconstituencies.

ABSTRACT

Thereisgreatpotentialfordisseminatingevidence-basedfindingsthroughclinicaldecisionsupport(CDS)toimprovepatient-centeredcare,healthcarequality,andalearninghealthsystem.AlthoughCDSingeneralhasbeenshowntoprovidediscretebenefits,despitetheseminalworkfromWennberg andMulley1,therehasnotbeenwidespreadadoptionofCDSorotherhealthtechnologiesforpromotingsharedmedicaldecisionmakingordisseminatingpatient-centeredoutcomesresearch.PCCDSisanew

TheAFAwasdevelopedfromiterativediscussionswithmultiplestakeholdergroupsthatmakeuptheLearningNetworkincludingpatientadvocates,providerorganizations,payers,CDScontentandelectronichealthrecordvendorstonameafew.ThefinalversionanditskeyfactorswasapprovedbytheLearningNetwork’sSteeringCommittee.Seethedefinedkeyfactorsinthecoloredbarsatright.

PreliminaryfindingsintheapplicationoftheAFAskeyfactorsinclude:

PRIORITIZING:Prioritizingevidence-basedfindingsrequiresmultiplestakeholdersdevelopingcriteriaandusecases.AUTHORING:Identifiedtheneedtoengagestakeholdersinpromotingstandards,methods,andtoolsnecessarytocreateactionable,implementablePCCDS.IMPLEMENTING:Elucidatedthatresearchpromotionandknowledge-sharingisneededaroundwaysPCCDScanbeandarebeingoperationalizedforpeopleandtheircaregivers.MEASURING:ThevariouswaysthatdisseminationofPCCDSmeasurablyimpactshealthandhealthcareoutcomesareobservableandcanbeutilizedtoimprovefuturecare.LEARNING:DevelopingpartnershipswithrelevantorganizationssuchasthePatient-CenteredOutcomesResearchInstitute(PCORI)andtheLearningHealthCommunitytotranslatePCCDSintoaLearningHealthSystem.EXTERNALFACTORS: Thereisaneedtoprovideaworkingdefinitionfor“PCCDS”.

ThePCCDSAFAisanimportantconceptualframeworktohelpguidethecreation,identification,prioritization,implementation,andevaluationofPCCDS.Thisisacriticalstepintheefforttowardenhancingtheprobabilityofsuccessfullytranslatingpatient-centeredfindings(includingPCOR)intoCDSforclinicalpractice.TheAFAwasdevelopedbyagroupofpatient-centered,PCOR,andCDSexpertsinconjunctionwiththeexecutionofaninitialenvironmentalscan,whichprovidedakeyinitialtesting

1KasperJF,Mulley AGJr,WennbergJE.Developingshareddecision-makingprogramstoimprovethequalityofhealthcare.QRBQual RevBull.1992Jun;18(6):183-90.PubMedPMID:1379705.

Formoreinformation,visit:www.pccds-ln.org

• PCORCDS-LNLeadershipTeam:PIBarryBlumenfeld,MD,MS,BlackfordMiddleton,MD,MPH,MSc;JeromeOsheroff,MD;andKensaku Kawamoto,MD,PhD,MHS

• RTIResearchers:LauraMarcial,PhD(lmarcial@rti.org);JoshuaRichardson,PhD;MelissaCallaham,MSPH,BethLasater,MSPH

• AHRQGrantdetails:o ProgramOfficial:EdwinLomotano GrantNo:U18HS24849-01o Periodofperformance:4/1/2016– 1/31/2020

PRIORITIZING: ApplyingobjectivemeasuresofevidenceforidentifyingandprioritizingfindingsthataretobetransformedanddisseminatedviaPCCDS,assessingordefiningtheirimplementability,anddefiningstewardshipandgovernancerequirements.

AUTHORING: ApplyingaccepteddataandknowledgestandardsfortranslatingfindingsintooneormorePCCDSinterventiontypesthatsupportkeydecisions,actions,andcommunicationsthatareessentialtoensuringthatthefindingimprovescareandoutcomes.

IMPLEMENTING: Applyingstandardized,bestpracticemethodsandarchitecturesforoperationalizingPCCDSinterventionsintoclinicalworkflowsthatdelivertherightinformationtotherightuserintherightformatthroughtherightchannelattherighttime("CDSFiveRights").

MEASURING: EnsuringthatPCCDSinterventionsmeasurablyimproveclinicianandpatientdecision-making,careprocesses,andoutcomes.

LEARNING: AggregatinglocalPCCDS-relatedoutcomesandeffectivenessmeasurestofacilitatebothlocalandsystem-levellearningfromidentifiedgapsinPCORknowledge,andlessonslearnedfromauthoring,implementing,andusingPCCDSinclinicalpracticetoenhancecareandoutcomes.

EXTERNALFACTORS: Externalfactorsincludingthemarketplace,policy,legal,andgovernanceissuesthatimpactdevelopment,dissemination,andimplementationprocessesforPCCDS.

approachtodisseminatingevidence-basedfindings(includingPCOR)throughCDS.However,aconceptualmodelofPCCDSisneededtohelpelucidatewhatPCCDSisandhowitcanbeoperationalized.Topromoteadvancesinthisarea,wedevelopeda“springboardforaction”tofosteranecosystemthatallowsallstakeholderstoreducethefrictionofturningknowledgefrompatient-centeredfindingsintoCDS-enabledactionstoproducebettercareandoutcomes.ThePCCDSAnalyticFrameworkforAction(AFA)identifiesthestepsinthisprocessthatmustbeaddressedtomakeprogress.

environmentforitsapplicability.Furtherapplicationoftheframeworkiswarrantedtoevaluateitslongtermviability.

LauraHaak Marcial,PhD1,JoshuaRichardson,PhD1,BarryBlumenfeld,MD,MS1,1RTIInternational,RTP,NC,USA