The Influence of Clinical Decision Support on Diagnostic Accuracy in Nurse Practitioners

Research output: Contribution to journalArticle

Abstract

Background: Clinical decision support systems (CDSSs) at the point of care are evidence-based interventions that have demonstrated incremental positive impact on quality of healthcare delivery over the past two decades. Existing best practices inform strategies to promote adoption and achievement of targeted outcomes. The purpose of this improvement project was to conduct a pilot implementation to understand the contextual factors and readiness for dissemination of a newly acquired electronic CDSS by evaluating its influence on diagnostic accuracy in nurse practitioners (NPs) functioning in a community health setting. Aims: The specific aims of this project were to measure and compare diagnostic accuracy in a pilot group before and after CDSS use, educate clinicians about the system and pilot its use, and then leverage the experience to design the practice-wide CDSS dissemination strategy. Methods: The project engaged a subset of NPs from a home-based primary care practice and other organizational stakeholders who provided tangible support and necessary resources for successful adoption of this innovation in practice. A structured conceptual model of Evidence-Based Practice Improvement enhanced with elements of the Promoting Action on Research Implementation in Health Sciences framework was used to guide the development, implementation and evaluation of this practice improvement initiative. A group of seven NP representatives of the practice participated in the project. Data collection was composed of small tests of change (plan-do-study-act) cycles at the local practice level, measuring achievement of improvement of the chosen outcome of correctness of medical diagnosis evidenced by appropriate substantiating clinical documentation. Linking evidence to action: In this home visiting primary care practice setting, use of a CDSS by NPs achieved eventual improvement in diagnostic accuracy and clinical documentation, as demonstrated on chart audit, though the improvement was not sustained over time. The pilot findings ultimately informed decision making about CDSS dissemination strategies and future uses of the system. When appropriately deployed, a CDSS offers the potential to improve professional practice, support differential diagnosis and evidence-based treatment, and provide detailed information about the disease state to facilitate robust clinical documentation.

Original languageEnglish (US)
Pages (from-to)355-363
Number of pages9
JournalWorldviews on Evidence-Based Nursing
Volume12
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Clinical Decision Support Systems
Nurse Practitioners
Documentation
Primary Health Care
Point-of-Care Systems
Professional Practice
Quality of Health Care
Evidence-Based Practice
Health Services Research
Health
Practice Guidelines
Decision Making
Differential Diagnosis
Delivery of Health Care

Keywords

  • Clinical decision support system
  • Diagnosis
  • Evidence-Based Practice Improvement model
  • Nurse practitioner
  • Pilot study
  • Promoting action research in health sciences framework

ASJC Scopus subject areas

  • Nursing(all)

Cite this

The Influence of Clinical Decision Support on Diagnostic Accuracy in Nurse Practitioners. / Vetter, Mary.

In: Worldviews on Evidence-Based Nursing, Vol. 12, No. 6, 01.12.2015, p. 355-363.

Research output: Contribution to journalArticle

@article{62c128e8c7db4a768450c5340d402891,
title = "The Influence of Clinical Decision Support on Diagnostic Accuracy in Nurse Practitioners",
abstract = "Background: Clinical decision support systems (CDSSs) at the point of care are evidence-based interventions that have demonstrated incremental positive impact on quality of healthcare delivery over the past two decades. Existing best practices inform strategies to promote adoption and achievement of targeted outcomes. The purpose of this improvement project was to conduct a pilot implementation to understand the contextual factors and readiness for dissemination of a newly acquired electronic CDSS by evaluating its influence on diagnostic accuracy in nurse practitioners (NPs) functioning in a community health setting. Aims: The specific aims of this project were to measure and compare diagnostic accuracy in a pilot group before and after CDSS use, educate clinicians about the system and pilot its use, and then leverage the experience to design the practice-wide CDSS dissemination strategy. Methods: The project engaged a subset of NPs from a home-based primary care practice and other organizational stakeholders who provided tangible support and necessary resources for successful adoption of this innovation in practice. A structured conceptual model of Evidence-Based Practice Improvement enhanced with elements of the Promoting Action on Research Implementation in Health Sciences framework was used to guide the development, implementation and evaluation of this practice improvement initiative. A group of seven NP representatives of the practice participated in the project. Data collection was composed of small tests of change (plan-do-study-act) cycles at the local practice level, measuring achievement of improvement of the chosen outcome of correctness of medical diagnosis evidenced by appropriate substantiating clinical documentation. Linking evidence to action: In this home visiting primary care practice setting, use of a CDSS by NPs achieved eventual improvement in diagnostic accuracy and clinical documentation, as demonstrated on chart audit, though the improvement was not sustained over time. The pilot findings ultimately informed decision making about CDSS dissemination strategies and future uses of the system. When appropriately deployed, a CDSS offers the potential to improve professional practice, support differential diagnosis and evidence-based treatment, and provide detailed information about the disease state to facilitate robust clinical documentation.",
keywords = "Clinical decision support system, Diagnosis, Evidence-Based Practice Improvement model, Nurse practitioner, Pilot study, Promoting action research in health sciences framework",
author = "Mary Vetter",
year = "2015",
month = "12",
day = "1",
doi = "10.1111/wvn.12121",
language = "English (US)",
volume = "12",
pages = "355--363",
journal = "Worldviews on Evidence-Based Nursing",
issn = "1545-102X",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - The Influence of Clinical Decision Support on Diagnostic Accuracy in Nurse Practitioners

AU - Vetter, Mary

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background: Clinical decision support systems (CDSSs) at the point of care are evidence-based interventions that have demonstrated incremental positive impact on quality of healthcare delivery over the past two decades. Existing best practices inform strategies to promote adoption and achievement of targeted outcomes. The purpose of this improvement project was to conduct a pilot implementation to understand the contextual factors and readiness for dissemination of a newly acquired electronic CDSS by evaluating its influence on diagnostic accuracy in nurse practitioners (NPs) functioning in a community health setting. Aims: The specific aims of this project were to measure and compare diagnostic accuracy in a pilot group before and after CDSS use, educate clinicians about the system and pilot its use, and then leverage the experience to design the practice-wide CDSS dissemination strategy. Methods: The project engaged a subset of NPs from a home-based primary care practice and other organizational stakeholders who provided tangible support and necessary resources for successful adoption of this innovation in practice. A structured conceptual model of Evidence-Based Practice Improvement enhanced with elements of the Promoting Action on Research Implementation in Health Sciences framework was used to guide the development, implementation and evaluation of this practice improvement initiative. A group of seven NP representatives of the practice participated in the project. Data collection was composed of small tests of change (plan-do-study-act) cycles at the local practice level, measuring achievement of improvement of the chosen outcome of correctness of medical diagnosis evidenced by appropriate substantiating clinical documentation. Linking evidence to action: In this home visiting primary care practice setting, use of a CDSS by NPs achieved eventual improvement in diagnostic accuracy and clinical documentation, as demonstrated on chart audit, though the improvement was not sustained over time. The pilot findings ultimately informed decision making about CDSS dissemination strategies and future uses of the system. When appropriately deployed, a CDSS offers the potential to improve professional practice, support differential diagnosis and evidence-based treatment, and provide detailed information about the disease state to facilitate robust clinical documentation.

AB - Background: Clinical decision support systems (CDSSs) at the point of care are evidence-based interventions that have demonstrated incremental positive impact on quality of healthcare delivery over the past two decades. Existing best practices inform strategies to promote adoption and achievement of targeted outcomes. The purpose of this improvement project was to conduct a pilot implementation to understand the contextual factors and readiness for dissemination of a newly acquired electronic CDSS by evaluating its influence on diagnostic accuracy in nurse practitioners (NPs) functioning in a community health setting. Aims: The specific aims of this project were to measure and compare diagnostic accuracy in a pilot group before and after CDSS use, educate clinicians about the system and pilot its use, and then leverage the experience to design the practice-wide CDSS dissemination strategy. Methods: The project engaged a subset of NPs from a home-based primary care practice and other organizational stakeholders who provided tangible support and necessary resources for successful adoption of this innovation in practice. A structured conceptual model of Evidence-Based Practice Improvement enhanced with elements of the Promoting Action on Research Implementation in Health Sciences framework was used to guide the development, implementation and evaluation of this practice improvement initiative. A group of seven NP representatives of the practice participated in the project. Data collection was composed of small tests of change (plan-do-study-act) cycles at the local practice level, measuring achievement of improvement of the chosen outcome of correctness of medical diagnosis evidenced by appropriate substantiating clinical documentation. Linking evidence to action: In this home visiting primary care practice setting, use of a CDSS by NPs achieved eventual improvement in diagnostic accuracy and clinical documentation, as demonstrated on chart audit, though the improvement was not sustained over time. The pilot findings ultimately informed decision making about CDSS dissemination strategies and future uses of the system. When appropriately deployed, a CDSS offers the potential to improve professional practice, support differential diagnosis and evidence-based treatment, and provide detailed information about the disease state to facilitate robust clinical documentation.

KW - Clinical decision support system

KW - Diagnosis

KW - Evidence-Based Practice Improvement model

KW - Nurse practitioner

KW - Pilot study

KW - Promoting action research in health sciences framework

UR - http://www.scopus.com/inward/record.url?scp=84958755336&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958755336&partnerID=8YFLogxK

U2 - 10.1111/wvn.12121

DO - 10.1111/wvn.12121

M3 - Article

C2 - 26630088

AN - SCOPUS:84958755336

VL - 12

SP - 355

EP - 363

JO - Worldviews on Evidence-Based Nursing

JF - Worldviews on Evidence-Based Nursing

SN - 1545-102X

IS - 6

ER -