Implementing Clinical Decision Support for Primary Care Preventive Screenings for People with Physical Disabilities

People with physical disabilities are one of the largest subgroups of people with disabilities, and this group experiences significant health disparities. Given the risk of preventable multimorbidity among this group, there is an opportunity to improve primary care for this population.The goal of this study was to use a clinical decision support (CDS) tool to improve preventive screenings in primary care for people with physical disabilities.We used a convergent mixed methods study design-integrating quantitative and qualitative data-within a pilot implementation study. Our CDS intervention was implemented at a single, family medicine clinic in an academic medical center in southeast Michigan. Quantitative data were focused on providers using the CDS tool within the electronic health record, while qualitative data were gathered from group meetings and semi-structured interviews with primary care providers at the intervention clinic.The CDS tool was triggered for 1,668 unique encounters and was used only 10% of the time. Among use cases, a recommended preventive screening order was placed 40% of the time. Three themes were developed, focused on (1) inadequate incentive and cognitive task management systems, (2) competing priorities and patient burden, and (3) liking the CDS alert.Although receptive, primary care providers in our study infrequently used the CDS alert. Through merging these mixed methods data, we identified several opportunities to improve the CDS tool including reducing cognitive burden, providing details on the justification for the recommended orders, and better workflow integration.