Abstract
Background The overuse of cranial computed tomography (CT) to diagnose potential traumatic brain injuries (TBIs) exposes children with minor blunt head trauma to unnecessary ionizing radiation. The Pediatric Emergency Care Applied Research Network and the Clinical Research on Emergency Services and Treatments Network implemented TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) to decrease use of CTs in children with minor blunt head trauma. Objective This article aims to facilitate implementation and dissemination of a CDS alert into emergency departments around the country. Methods We evaluated the EHR CT CDS tool through a mixed-methods analysis of 38 audio-recorded interviews with health care stakeholders and quantitative data sources, using the Reach, Efficacy, Adoption, Implementation, and Maintenance framework. Results Reach -- The demographics of participants enrolled in the clinical trial were consistent with national estimates of TBI prevalence. Efficacy --There was a variable and modest reduction in CT rates for the 8,067 children with minor head trauma whose clinicians received CDS. Adoption -- The EHR CT CDS tool was well matched with the organizational mission, values, and priorities of the implementation sites. Implementation -- The most important predisposing factors for successful implementation were the presence of an approachable clinical champion at each site and belief that the tool was a relevant, reusable knowledge asset. Enabling factors included an effective integration within the clinical workflow, organizational investment in user training, and ease of use. Maintenance -- Reinforcing factors for the EHR CT CDS tool included a close fit with the institutional culture, belief that it was useful for providers and families, and a good educational and informational tool. As such, the EHR CT CDS tool was maintained in clinical practice long after study completion. Conclusion Data from this mixed-methods study complement findings from the efficacy trial and provide critical components for consideration prior to integration and subsequent dissemination of the EHR CT CDS tool. Trial Registration NCT01453621, Registered September 27, 2011.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 693-703 |
| Number of pages | 11 |
| Journal | Applied Clinical Informatics |
| Volume | 9 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jul 1 2018 |
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Keywords
- blunt head trauma
- child
- clinical decision support
- clinical trial
- implementation
- traumatic brain injury
ASJC Scopus subject areas
- Health Informatics
- Computer Science Applications
- Health Information Management
Cite this
Applying the RE-AIM Framework for the Evaluation of a Clinical Decision Support Tool for Pediatric Head Trauma : A Mixed-Methods Study. / Masterson Creber, Ruth M.; Dayan, Peter S.; Kuppermann, Nathan; Ballard, Dustin W.; Tzimenatos, Leah S; Alessandrini, Evaline; Mistry, Rakesh D.; Hoffman, Jeffrey; Vinson, David R.; Bakken, Suzanne.
In: Applied Clinical Informatics, Vol. 9, No. 3, 01.07.2018, p. 693-703.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Applying the RE-AIM Framework for the Evaluation of a Clinical Decision Support Tool for Pediatric Head Trauma
T2 - A Mixed-Methods Study
AU - Masterson Creber, Ruth M.
AU - Dayan, Peter S.
AU - Kuppermann, Nathan
AU - Ballard, Dustin W.
AU - Tzimenatos, Leah S
AU - Alessandrini, Evaline
AU - Mistry, Rakesh D.
AU - Hoffman, Jeffrey
AU - Vinson, David R.
AU - Bakken, Suzanne
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background The overuse of cranial computed tomography (CT) to diagnose potential traumatic brain injuries (TBIs) exposes children with minor blunt head trauma to unnecessary ionizing radiation. The Pediatric Emergency Care Applied Research Network and the Clinical Research on Emergency Services and Treatments Network implemented TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) to decrease use of CTs in children with minor blunt head trauma. Objective This article aims to facilitate implementation and dissemination of a CDS alert into emergency departments around the country. Methods We evaluated the EHR CT CDS tool through a mixed-methods analysis of 38 audio-recorded interviews with health care stakeholders and quantitative data sources, using the Reach, Efficacy, Adoption, Implementation, and Maintenance framework. Results Reach -- The demographics of participants enrolled in the clinical trial were consistent with national estimates of TBI prevalence. Efficacy --There was a variable and modest reduction in CT rates for the 8,067 children with minor head trauma whose clinicians received CDS. Adoption -- The EHR CT CDS tool was well matched with the organizational mission, values, and priorities of the implementation sites. Implementation -- The most important predisposing factors for successful implementation were the presence of an approachable clinical champion at each site and belief that the tool was a relevant, reusable knowledge asset. Enabling factors included an effective integration within the clinical workflow, organizational investment in user training, and ease of use. Maintenance -- Reinforcing factors for the EHR CT CDS tool included a close fit with the institutional culture, belief that it was useful for providers and families, and a good educational and informational tool. As such, the EHR CT CDS tool was maintained in clinical practice long after study completion. Conclusion Data from this mixed-methods study complement findings from the efficacy trial and provide critical components for consideration prior to integration and subsequent dissemination of the EHR CT CDS tool. Trial Registration NCT01453621, Registered September 27, 2011.
AB - Background The overuse of cranial computed tomography (CT) to diagnose potential traumatic brain injuries (TBIs) exposes children with minor blunt head trauma to unnecessary ionizing radiation. The Pediatric Emergency Care Applied Research Network and the Clinical Research on Emergency Services and Treatments Network implemented TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) to decrease use of CTs in children with minor blunt head trauma. Objective This article aims to facilitate implementation and dissemination of a CDS alert into emergency departments around the country. Methods We evaluated the EHR CT CDS tool through a mixed-methods analysis of 38 audio-recorded interviews with health care stakeholders and quantitative data sources, using the Reach, Efficacy, Adoption, Implementation, and Maintenance framework. Results Reach -- The demographics of participants enrolled in the clinical trial were consistent with national estimates of TBI prevalence. Efficacy --There was a variable and modest reduction in CT rates for the 8,067 children with minor head trauma whose clinicians received CDS. Adoption -- The EHR CT CDS tool was well matched with the organizational mission, values, and priorities of the implementation sites. Implementation -- The most important predisposing factors for successful implementation were the presence of an approachable clinical champion at each site and belief that the tool was a relevant, reusable knowledge asset. Enabling factors included an effective integration within the clinical workflow, organizational investment in user training, and ease of use. Maintenance -- Reinforcing factors for the EHR CT CDS tool included a close fit with the institutional culture, belief that it was useful for providers and families, and a good educational and informational tool. As such, the EHR CT CDS tool was maintained in clinical practice long after study completion. Conclusion Data from this mixed-methods study complement findings from the efficacy trial and provide critical components for consideration prior to integration and subsequent dissemination of the EHR CT CDS tool. Trial Registration NCT01453621, Registered September 27, 2011.
KW - blunt head trauma
KW - child
KW - clinical decision support
KW - clinical trial
KW - implementation
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85057618478&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85057618478&partnerID=8YFLogxK
U2 - 10.1055/s-0038-1669460
DO - 10.1055/s-0038-1669460
M3 - Article
C2 - 30184559
AN - SCOPUS:85057618478
VL - 9
SP - 693
EP - 703
JO - Applied Clinical Informatics
JF - Applied Clinical Informatics
SN - 1869-0327
IS - 3
ER -