Today, the research team behind CHOP’s Minds Matter concussion program released a new study in Clinical Pediatrics detailing the impact of implementing electronic health record (EHR)-based clinical decision support tools for use throughout CHOP’s primary care network. In short, we found a robust and quick uptake of the concussion management strategies supported by the tools. (You can read the press release and abstract by clicking on the links below to get details about the findings.)
I want to share with Research in Action readers the deliberate thought process behind the development of the clinical support tools, which were designed to increase clinicians’ documentation in a patient EHR of conduct of a vestibular oculomotor exam and discussion of return-to-learn and return-to-play guidelines with patient families, two recommended concussion management strategies which were relatively new to many PCPs.
The Formative Research Among End Users
The decision to develop this clinical practice model at CHOP was motivated by increased numbers of youth seeking concussion care from CHOP primary care providers (PCP) and their demonstrated need for additional training and support.
In these previously published studies, we found that 82 percent of pediatric patients for whom CHOP is their primary care provider had their first concussion visit at a primary care practice. In surveys, many PCPs expressed that they did not feel equipped to manage concussions and were inclined to refer patients to specialists.
Historically, integrating new evidence into provider behavior can take many years. However, in this study we demonstrated a rather robust and quick uptake of the recommended management strategies.
Having a strong theoretical approach up front helped us with intervention design and deployment. First, through the PCP survey, we identified a clear clinical need and then we engaged the end-user clinicians in the design through follow-up survey and in-depth interviews.
End-user participation in the intervention development ensured that the tools addressed a real need and were feasible and acceptable to use.
The EHR-based tool was a Smartset (EpicCare®, Epic Systems, Inc.) template that prompted PCPs through a systematic diagnosis exam and a stepwise clinical management strategy.
We also provided hands-on provider training on use of the electronic clinical support tools and the new diagnostic exams during a wave of scheduled CME events at various CHOP Network sites.
Generally, the development of EHR-based clinical decision support tools represents a unique opportunity to provide clinical guidance across our geographically and socio-economically diverse group of providers and to change their behavior by promoting systematic implementation and documentation of emerging recommendations and practices.
Specifically, we demonstrated that such tools can increase PCP proficiency in concussion assessment, accelerate uptake of emerging knowledge, and promote practice consistency throughout an entire healthcare network.
Future efforts linking these provider behaviors to improvements in clinical outcomes are necessary advancements in this line of research.
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