Improving Quality by Maintaining Accurate Problems in the EHR

Summary

The overall goal of the IQ-MAPLE project is to improve the quality of care provided to patients with several heart, lung and blood conditions by facilitating more accurate and complete problem list documentation. In the first aim, the investigators will design and validate a series of problem inference algorithms, using rule-based techniques on structured data in the electronic health record (EHR) and natural language processing on unstructured data. Both of these techniques will yield candidate problems that the patient is likely to have, and the results will be integrated. In Aim 2, the investigators will design clinical decision support interventions in the EHRs of the four study sites to alert physicians when a candidate problem is detected that is missing from the patient's problem list - the clinician will then be able to accept the alert and add the problem, override the alert, or ignore it entirely. In Aim 3, the investigators will conduct a randomized trial and evaluate the effect of the problem list alert on three endpoints: alert acceptance, problem list addition rate and clinical quality.

Conditions

• Asthma
• Atrial Fibrillation
• Chronic Obstructive Pulmonary Disease
• Coronary Artery Disease
• Congestive Heart Failure
• Hyperlipidemia
• Hypertension
• Myocardial Infarction
• Sickle Cell Disease
• Sleep Apnea
• Smoking
• Stroke
• Tuberculosis

Interventions

OTHER

Problem List Suggestion

Sites will configure their EHR systems so that alerts for these conditions will be triggered for providers in the intervention arm if the patient does not have the condition on her/his problem list. each alert will be actionable and allow the provider to add the problem to her or his patient's problem list with a single click. The provider will also be able to override the rule of the patient does not have the condition (in which case the alert will not be displayed again unless new information that would trigger the alert is added to the patient's record), or defer the alert until later.

Sponsors & Collaborators

• Geisinger Clinic

  collaborator OTHER

• Oregon Health and Science University

  collaborator OTHER

• Vanderbilt University

  collaborator OTHER

• Brigham and Women's Hospital

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2016-04-30

Primary Completion

2018-03-31

Countries

• United States

Study Locations