Apathy Nate C, Sanner Lindsey, Adams Meredith C B, Mamlin Burke W, Grout Randall W, Fortin Saura, Hillstrom Jennifer, Saha Amit, Teal Evgenia, Vest Joshua R, Menachemi Nir, Hurley Robert W, Harle Christopher A, Mazurenko Olena
Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA.
JAMIA Open. 2022 Sep 15;5(3):ooac074. doi: 10.1093/jamiaopen/ooac074. eCollection 2022 Oct.
Given time constraints, poorly organized information, and complex patients, primary care providers (PCPs) can benefit from clinical decision support (CDS) tools that aggregate and synthesize problem-specific patient information. First, this article describes the design and functionality of a CDS tool for chronic noncancer pain in primary care. Second, we report on the retrospective analysis of real-world usage of the tool in the context of a pragmatic trial.
The tool known as OneSheet was developed using user-centered principles and built in the Epic electronic health record (EHR) of 2 health systems. For each relevant patient, OneSheet presents pertinent information in a single EHR view to assist PCPs in completing guideline-recommended opioid risk mitigation tasks, review previous and current patient treatments, view patient-reported pain, physical function, and pain-related goals.
Overall, 69 PCPs accessed OneSheet 2411 times (since November 2020). PCP use of OneSheet varied significantly by provider and was highly skewed (site 1: median accesses per provider: 17 [interquartile range (IQR) 9-32]; site 2: median: 8 [IQR 5-16]). Seven "power users" accounted for 70% of the overall access instances across both sites. OneSheet has been accessed an average of 20 times weekly between the 2 sites.
Modest OneSheet use was observed relative to the number of eligible patients seen with chronic pain.
Organizations implementing CDS tools are likely to see considerable provider-level variation in usage, suggesting that CDS tools may vary in their utility across PCPs, even for the same condition, because of differences in provider and care team workflows.
鉴于时间限制、信息组织不佳以及患者情况复杂，初级保健提供者（PCP）可从汇总和综合特定问题患者信息的临床决策支持（CDS）工具中受益。首先，本文描述了一种用于初级保健中慢性非癌性疼痛的CDS工具的设计和功能。其次，我们报告了在一项务实试验背景下对该工具实际使用情况的回顾性分析。
名为OneSheet的工具是采用以用户为中心的原则开发的，并内置在2个医疗系统的Epic电子健康记录（EHR）中。对于每个相关患者，OneSheet在单个EHR视图中呈现相关信息，以协助PCP完成指南推荐的阿片类药物风险缓解任务、回顾患者既往和当前的治疗情况、查看患者报告的疼痛、身体功能以及与疼痛相关的目标。
总体而言，自2020年11月以来，69名PCP访问OneSheet共2411次。PCP对OneSheet的使用因提供者而异，且高度不均衡（地点1：每个提供者的访问中位数：17次[四分位间距（IQR）9 - 32]；地点2：中位数：8次[IQR 5 - 16]）。7名“频繁使用者”占两个地点总体访问实例的70%。两个地点之间，OneSheet平均每周被访问20次。
相对于慢性疼痛患者的数量，OneSheet的使用情况较为有限。
实施CDS工具的组织可能会发现提供者层面的使用差异很大，这表明即使针对相同病症，由于提供者和护理团队工作流程的差异，CDS工具在不同PCP中的效用可能会有所不同。
