Reduction in Clinical Variance Using Targeted Design Changes in Computerized Provider Order Entry Order (CPOE) Sets

Study Overview
=================
Brief Summary
-----------------
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.

Detailed Description
-----------------
Variance in ordering of care can be characterized as the lack of uniform use of specific treatments by clinicians for a given medical condition. Unwarranted variance in healthcare has been associated with prolonged length of stay, diminished health and increased cost. Practice variation in the management of asthma can be significant and few investigators have evaluated strategies to reduce this variation. 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.

Official Title
-----------------
Reduction in Clinical Variance Using Targeted Design Changes in Computerized Provider Order Entry Order (CPOE) Sets

Conditions
-----------------
Asthma Exacerbation

Intervention / Treatment
-----------------
* Other: Evidence Based Intervention to order set


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: All patients admitted using an acute asthma exacerbation order set. Exclusion Criteria: Patients who did not have either an admission or discharge diagnosis of asthma exacerbation. In addition, patients admitted to the intensive care unit directly or transferred to the intensive care unit within 24-hours were excluded from analysis. Finally, patients were excluded from analysis if asthma was not the presenting problem.
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Baseline Period<br>Patients in the baseline period were cared for using the standard historical electronic order set. | |
| Active Comparator: Post Intervention Period<br>Patients in the Post intervention period were cared for with evidence-bsed modified order set changes | Other: Evidence Based Intervention to order set<br>* The order set was altered to include evidence based care items<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reduced variation from in evidence-based care through integrating evidence into the clinician workflow in the EMR system. |  | 2 years | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Asthma, Children, CPOE, Decision Support, Framing, Heuristic, Order Sets