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Related Experiment Videos

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

B R Jacobs1, K W Hart, D W Rucker

  • 1Children's National Medical Center , Washington, DC.

Applied Clinical Informatics
|April 26, 2013
PubMed
Summary

Redesigning electronic health record order sets improved adherence to asthma care guidelines. This intervention enhanced the use of key orders, reducing practice variance and improving evidence-based care delivery.

Keywords:
AsthmaCPOEchildrendecision supportframingheuristicorder sets

Related Experiment Videos

Area of Science:

  • Healthcare quality improvement
  • Clinical informatics
  • Asthma management

Background:

  • Unwarranted healthcare variance increases costs and negatively impacts patient outcomes.
  • Significant practice variations exist in asthma management.
  • Strategies to reduce this variance are not widely evaluated.

Purpose of the Study:

  • To test if redesigning order sets in a computerized provider order entry (CPOE) system improves adherence to evidence-based asthma care.
  • To reduce population-specific variance in asthma management through targeted order set modifications.

Main Methods:

  • The study evaluated an evidence-based asthma exacerbation order set in the electronic health record (EHR) before and after redesign.
  • Data on order set utilization were collected during Baseline and Post-Intervention periods.
  • Suboptimal order utilization was identified and targeted for redesign within the order set.

Main Results:

  • Order set redesign significantly improved the utilization of targeted care items: admission weight (79.2% to 94.8%), activity center (84.1% to 95.3%), and peak flow measurements (18.8% to 55.9%).
  • Peak flow order utilization for children aged 8 and older increased from 42.7% to 94.1% post-intervention.
  • The redesign led to improved selection of evidence-based care elements.

Conclusions:

  • Order set design critically influences clinician prescribing behavior.
  • Electronic health record data can identify ordering variances.
  • Targeted redesign of order sets within CPOE systems effectively enhances the adoption of evidence-based practices.