ArticleApplied clinical informatics2012
Reduction in Clinical Variance Using Targeted Design Changes in Computerized Provider Order Entry (CPOE) Order Sets: Impact on Hospitalized Children with Acute Asthma Exacerbation.
Article in Applied clinical informatics, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2023Pooled it
- User Experience Design for Adoption of Asthma Clinical Decision Support Tools.Applied clinical informatics · 2022Article
- The Role of Electronic Medical Records in Reducing Unwarranted Clinical Variation in Acute Health Care: Systematic Review.JMIR medical informatics · 2021Review
- The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit.Applied clinical informatics · 2020Article
- When order sets do not align with clinician workflow: assessing practice patterns in the electronic health record.BMJ quality & safety · 2019Article
- Effect of default order set settings on telemetry ordering.Journal of the American Medical Informatics Association : JAMIA · 2019Article
- Sustained Improvement in Inflammatory Bowel Disease Quality Measures Using an Electronic Health Record Intervention.Applied clinical informatics · 2019Article
- A Quality Improvement Initiative to Decrease Platelet Ordering Errors and a Proposed Model for Evaluating Clinical Decision Support Effectiveness.Applied clinical informatics · 2019Article
- Exploring Different Approaches in Measuring EHR-based Adherence to Best Practice - A Case Study with Order Sets and Associated Outcomes.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2019Article
- Decaying relevance of clinical data towards future decisions in data-driven inpatient clinical order sets.International journal of medical informatics · 2017Article
- Predicting inpatient clinical order patterns with probabilistic topic models vs conventional order sets.Journal of the American Medical Informatics Association : JAMIA · 2017Article
- Extracting Actionable Recommendations for Modifying Enterprise Order Set Templates from CPOE Utilization Patterns.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2017Article
- Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention.Journal of the American Heart Association · 2016Article
- Observational
- Visualization of Order Set Creation and Usage Patterns in Early Implementation Phases of an Electronic Health Record.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2016Article
- Personalization and Patient Involvement in Decision Support Systems: Current Trends.Yearbook of medical informatics · 2015Review
- Default settings of computerized physician order entry system order sets drive ordering habits.Journal of pathology informatics · 2015Article
- Paving the COWpath: data-driven design of pediatric order sets.Journal of the American Medical Informatics Association : JAMIA · 2014Article
- De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative.Pediatric quality & safetyArticle
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesUnwarranted variance in healthcare has been associated with prolonged length of stay, diminished health and increased cost. Practice variance in the management of asthma can be significant and few investigators have evaluated strategies to reduce this variance. We hypothesized that selective redesign of order sets using different ways to frame the order and physician decision-making in a computerized provider order entry system could increase adherence to evidence-based care and reduce population-specific variance. PATIENTS AND
methodsThe study focused on the use of an evidence-based asthma exacerbation order set in the electronic health record (EHR) before and after order set redesign. In the Baseline period, the EHR was queried for frequency of use of an asthma exacerbation order set and its individual orders. Important individual orders with suboptimal use were targeted for redesign. Data from a Post-Intervention period were then analyzed.
resultsIn the Baseline period there were 245 patient visits in which the acute asthma exacerbation order set was selected. The utilization frequency of most orders in the order set during this period exceeded 90%. Three care items were targeted for intervention due to suboptimal utilization: admission weight, activity center use and peak flow measurements. In the Post-Intervention period there were 213 patient visits. Order set redesign using different default order content resulted in significant improvement in the utilization of orders for all 3 items: admission weight (79.2% to 94.8% utilization, p<0.001), activity center (84.1% to 95.3% utilization, p<0.001) and peak flow (18.8% to 55.9% utilization, p<0.001). Utilization of peak flow orders for children ≥8 years of age increased from 42.7% to 94.1% (p<0.001).
conclusionsDetails of order set design greatly influence clinician prescribing behavior. Queries of the EHR reveal variance associated with ordering frequencies. Targeting and changing order set design elements in a CPOE system results in improved selection of evidence-based care.
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