Incorporating guideline adherence and practice implementation issues into the design of decision support for beta-blocker titration for heart failure

Authors

Michael W. Smith, Universidad de las Americas Puebla, Cholula, PUE, Mexico
Charnetta Brown, Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
Salim S. Virani, Baylor College of Medicine, Houston, Texas, United StatesFollow
Charlene R. Weir, University of Utah, Salt Lake City, Utah, United States
Laura A. Petersen, Baylor College of Medicine, Houston, Texas, United States
Natalie Kelly, Salt Lake City VA Health Care System HSR&D Informatics

Document Type

Article

Department

Cardiology

Abstract

Background: The recognition of and response to undertreatment of heart failure (HF) patients can be complicated. A clinical reminder can facilitate use of guideline-concordant β-blocker titration for HF patients with depressed ejection fraction. However, the design must consider the cognitive demands on the providers and the context of the work.
Objective: This study's purpose is to develop requirements for a clinical decision support tool (a clinical reminder) by analyzing the cognitive demands of the task along with the factors in the Cabana framework of physician adherence to guidelines, the health information technology (HIT) sociotechnical framework, and the Promoting Action on Research Implementation in Health Services (PARIHS) framework of health services implementation. It utilizes a tool that extracts information from medical records (including ejection fraction in free text reports) to identify qualifying patients at risk of undertreatment.
Methods: We conducted interviews with 17 primary care providers, 5 PharmDs, and 5 Registered Nurses across three Veterans Health Administration outpatient clinics. The interviews were based on cognitive task analysis (CTA) methods and enhanced through the inclusion of the Cabana, HIT sociotechnical, and PARIHS frameworks. The analysis of the interview data led to the development of requirements and a prototype design for a clinical reminder. We conducted a small pilot usability assessment of the clinical reminder using realistic clinical scenarios.
Results: We identified organizational challenges (such as time pressures and underuse of pharmacists), knowledge issues regarding the guideline, and information needs regarding patient history and treatment status. We based the design of the clinical reminder on how to best address these challenges. The usability assessment indicated the tool could help the decision and titration processes

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Applied Clinical Informatics

Recommended Citation

Smith, M. W., Brown, C., Virani, S. S., Weir, C. R., Petersen, L. A., Kelly, N. (2018). Incorporating guideline adherence and practice implementation issues into the design of decision support for beta-blocker titration for heart failure. Applied Clinical Informatics, 9(2), 478-489.
Available at: https://ecommons.aku.edu/provost_office/405