Study of an Intervention to Improve Problem List Accuracy and Use

Study Overview
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Brief Summary
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The aim of this study is to identify patients with problem list gaps and intervene to correct these gaps by creating clinical decision support interventions that alert providers to likely problem list gaps and offer clinicians the opportunity to correct them. The investigators will randomize the clinics that will receive the intervention and formally evaluate the study after a period of 6 months for improved problem list completeness to determine the effectiveness of our intervention.

Detailed Description
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The clinical problem list is a cornerstone of the problem-oriented medical record. Problem lists are used in a variety of ways throughout the process of clinical care. In addition to its use by clinicians, the problem list is also critical for decision support and quality measurement. Patients with gaps in their problem list face significant risks. For example, if a hypothetical patient has diabetes properly documented, his clinician would receive appropriate alerts and reminders to guide care. Additionally, the patient might be included in special care management programs and the quality of care provided to him would be measured and tracked. Without diabetes on his problem list, he might receive none of these benefits. In this study, the investigators developed an clinical decision support intervention that will identify patients with problem lists gaps. The investigators will alert providers of these likely gaps and offer providers the opportunity to correct them.

Official Title
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Making Accurate Problem Lists in the EHR

Conditions
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Attention Deficit Disorder With Hyperactivity, Asthma, COPD, Breast Cancer, Coronary Artery Disease, Congestive Heart Failure, Diabetes, Glaucoma, Hemophilia, Hypertension, Hyperthyroidism, Hypothyroidism, Myasthenia Gravis, Osteoporosis, Osteopenia, Renal Failure, Renal Insufficiency, Sickle Cell Disease, Stroke

Intervention / Treatment
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* Other: MAPLE


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Independent healthcare provider (physician, NP, PA) Practices at participating site Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Receive CDS intervention<br>Providers in clinics that will receive the CDS alert, as their clinic was randomized into our study. | Other: MAPLE<br>* MAPLE is a CDS intervention within the EHR that will alert providers to problem lists gaps and present an opportunity to correct them.<br>|
| No Intervention: No CDS intervention<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intervention acceptance | Of those providers who were shown (or who would have been shown, for the control group) the intervention, the number that added a problem across control and intervention groups. | 6 months (May 2010-Nov2010) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Problem list prevalence | Number of patients with selected problems on their problem list pre and post intervention across intervention and control groups. | pre and post intervention | 
| Problem list incidence | For the conditions of interest, the percent of patients that had the problem added during the study period | pre and post intervention | 
| Quality improvement based on problem list accuracy/completion | For those with problems added due to the intervention, the number of new triggered reminders or other clinical actions. | post intervention |