A systematic review of theoretical constructs in CDS literature and how they influence adoption and implementation

A systematic review of theoretical constructs in CDS literature.
BMC Med Inform Decis Making March 2021,  21, 102 (2021). https://doi.org/10.1186/s12911-021-01465-2

• This review seeks to understand the features that impact adoption of clinical decision support systems and in turn, successful patient outcomes, by examining the psychological mechanisms that are key to these types of interventions. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) model to explore the psychological characteristics of CDS interventions to predict adoption identified in published research.

And follow up research using UTAUT:

A theory-based meta-regression of factors influencing clinical decision support adoption and implementation.
J Am Med Inform Assoc. 2021 Aug 13:ocab160. doi: 10.1093/jamia/ocab160.

• Analysis of published research of trials that compared a CDS intervention with and without specific factors identified three positive factors which affect CDS effectiveness. They were: low effort to use, low controllability, and providing more infrastructure and implementation strategies to support the CDS. The multivariate analysis suggests that passive CDS could be effective if users believe the CDS is useful and/or social expectations to use the CDS intervention exist.

Modelling tool to support decision-making in the NHS Health Check programme

Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users.
Health Technology Assessment 2021;25(35)

• This report discusses how delivery of the NHS Health Checks programme could be improved, in particular by the use of a web-based tool - workHORSE (working Health Outcomes Research Simulation Environment). A series of workshops with commissioners resulted in a useful ‘real-world’ tool for local commissioners that can calculate the current and potential future benefits of different programmes. The study examined different delivery programmes and their benefit in health and value and impact and reducing inequalities.

Barriers and facilitators to the adoption of electronic clinical decision support systems

Barriers and facilitators to the adoption of electronic clinical decision support systems: a qualitative interview study with UK general practitioners. 

BMC Med Inform Decis Mak. 2021 Jun 21;21(1):193. doi: 10.1186/s12911-021-01557-z.

• Interviews with 11 GPs in London and South England to discuss a hypothetical CDSS that could detect early signs of dementia identified three overarching themes: trust in individual CDSSs; usability of individual CDSSs; and usability of CDSSs in the broader practice context. Building on these findings the researchers make a number of recommendations for CDSS developers to consider when bringing a new CDSS into GP patient records systems.

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A thematic analysis to examine the feasibility of EHR-based clinical decision support for implementing Choosing Wisely® guidelines.

A thematic analysis to examine the feasibility of EHR-based clinical decision support for implementing Choosing Wisely® guidelines.
JAMIA Open. 2021 Jun 16;4(2):ooab031. doi: 10.1093/jamiaopen/ooab031.

• A thematic analysis of interviews with experts discussing the feasibility of implementing “Choosing Wisely” clinical practice guidelines (CPGs) (see UK version here) as clinical decision support (CDS). 
• The research identified five themes:
•  concern about data quality impacts implementation planning; 
• the availability of data in a computable format is a primary factor for implementation feasibility;
•  customized strategies are needed to mitigate uncertainty and ambiguity when translating CPGs to an electronic health record-based tool; 
• misalignment of expected CDS with pre-existing clinical workflows impact implementation; 
• and individual level factors of end-users must be considered when selecting and implementing CDS tools.

Developing place-based partnerships: the foundation of effective integrated care systems

Developing place-based partnerships: the foundation of effective integrated care systems
Kings Fund 20 April 2021

• The King’s Fund has reviewed existing evidence and experience on place-based working, explored the development of place-based partnerships within three systems and undertaken targeted engagement with local leaders from ICSs, local authorities and voluntary and community sector organisations. This research highlights the potential role of place-based partnerships in improving health and wellbeing and illustrates how these opportunities can be realised.

Proactive care frameworks (UCLP) for long term conditions

Proactive care frameworks
University College London Partners (UCLP) 15 February 2021

• UCLP have developed a series of proactive care frameworks to support primary care teams to manage patients with cardiovascular and respiratory long-term conditions. It includes search and risk stratification tools, pathways for local adaptation, workforce education and training and digital resources.
• Press release: Post-COVID recovery: proactive care, self care and CVD prevention | UCLPartners

Cancer diagnostic tools to aid decision-making in primary care

Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis.
Health Technol Assess November 2020;24(66)

• Two systematic reviews have been published which examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. 
• Results: Systematic review 1 – five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 – 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools.

GatewayC Cancer Maps

GatewayC Cancer Maps

• The Cancer Maps is an interactive reference tool for GPs based on the NICE NG12 cancer guidelines. Primarily, the tool is designed to enable GPs to take symptoms that patients present with during a consultation and map them on possible suspected cancer pathways.
• There are 4 main ways to use The Cancer Maps :
• As a quick reference to NICE guidance
• As a decision support tool
• As an educational tool
• With patients to reassure or safety net

Remote symptom monitoring integrated into electronic health records: A systematic review

Remote symptom monitoring integrated into electronic health records: A systematic review
Journal of the American Medical Informatics Association, ocaa177, 23 September 2020 https://doi.org/10.1093/jamia/ocaa177

• A systematic review identified 12 studies reporting 10 electronic health record-integrated remote symptom monitoring systems which remotely collect patient-reported symptoms, but found limited evidence that this improves care and outcomes.

What are the cost-savings and health benefits of improving detection and management for six high cardiovascular risk conditions in England?

What are the cost-savings and health benefits of improving detection and management for six high cardiovascular risk conditions in England? An economic evaluation
BMJ Open 2020;10:e037486. doi: 10.1136/bmjopen-2020-037486

• An economic analysis using the School for Public Health Research CVD Prevention Model indicates that £68 billion could be saved, 4.9 million QALYs gained and 3.4 million cases of CVD prevented over 25 years if all individuals in England with the six CVD high risk conditions were diagnosed and subsequently managed at current levels.

Clinical Decision Support for the Diagnosis and Management of Adult and Pediatric Hypertension.

Clinical Decision Support for the Diagnosis and Management of Adult and Pediatric Hypertension.
Current hypertension reports vol. 22,9 67. 27 Aug. 2020, doi:10.1007/s11906-020-01083-9

• A review of the literature from 2016 to 2019 on clinical decision support (CDS) for diagnosis and management of hypertension in children and adults identified 10 studies. Findings suggest that CDS increases hypertension detection/control, yet many children and adults with hypertension remain undetected or undercontrolled. CDS challenges included poor usability (from lack of health record integration, excessive data entry requests, and wireless connectivity challenges) and lack of clinician trust in blood pressure measures.

Coronavirus (COVID-19): remote care through telehealth

Special Collection: Coronavirus (COVID-19): remote care through telehealth
Cochrane Library updated 10 August 2020

• This Special Collection includes Cochrane Reviews that address using telehealth to support clinical management of various conditions, including asthma, diabetes, cardiovascular disease, dementia, reproductive health, and skin cancer. It includes reviews of using telehealth to provide carer and parent support as well as empowering patient self-management of their long-term conditions.

Internet access – households and individuals, Great Britain: 2020

Internet access – households and individuals, Great Britain: 2020
ONS latest update 7 August 2020

• Internet access in Great Britain, including how many people have internet access, what they use it for and online shopping. Based on a nationally representative sample of households in Great Britain. Includes:
• Table 6: Internet Activities, by Age Group, Sex and Disability Status, 2020
• "Looking for health-related information (eg injury, disease, nutrition, improving health etc)"
• Metrics added 2020 -
• "Making an appointment with a medical practitioner via a website or app"
• "Using other online health services via a website or app instead of having to go to the hospital or visit a doctor, for example getting a prescription or a consultation online"
• "Accessing personal health records online"

Improving the accuracy of medical diagnosis with causal machine learning

Improving the accuracy of medical diagnosis with causal machine learning.
Nat Commun 11, 3923 (2020). https://doi.org/10.1038/s41467-020-17419-7

• The authors (from Babylon Health)  argue that their counterfactual algorithm improves clinical decision making and diagnosis.

Abstract

Enabling individualised health in learning healthcare systems

Enabling individualised health in learning healthcare systems
BMJ Evidence-Based Medicine 2020;25:125-129.

• The Learning approach for Prediction, Interpretation/Inference and Communication (Learning PIC) framework is an approach for synergistic learning that draws on the strengths of machine learning as well as statistical approaches and clinical knowledge to address the challenges hindering the successful implementation of learning healthcare systems and to enable the effective delivery of evidence-based medicine.

Clinical pathways on a mobile device

Clinical pathways on a mobile device
BMJ Evidence-Based Medicine 2020;25:131-137

• This quality improvement project evaluated the potential use of digital clinical pathways in the primary care setting delivered on a mobile platform. Three new-to-practice [USA] primary care nurse practitioners participated in three plan-do-study-act cycles using these pathways installed on mobile devices to determine if they were a feasible, efficient and useful method to implement evidence.  

Abstract

Remodelling elective hospital services in the COVID-19 era – designing the new normal

Remodelling elective hospital services in the COVID-19 era – designing the new normal

Future Healthc J July 2020 DOI: https://doi.org/10.7861/fhj.2020-0079

• The provision of elective clinical services has decreased during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic to enable hospitals to focus on acute illness. Any end to the pandemic through widespread vaccination, effective treatment or development of herd immunity may be years away. Until then, hospitals will need to resume treating other diseases while also attempting to eradicate transmission of COVID-19 within the healthcare setting. 
• In this article we suggest six major themes which could affect the design and delivery of elective clinical services: hospital avoidance, separation of high- and low-risk groups, screening, maintenance of adequate infection control, and new ways of working.

Routes to Cancer Diagnosis 2010-2017

Routes to Cancer Diagnosis 2010-2017
National Cancer Registration and Analysis Service (NCRAS) 14 July 2020

• Routes to Diagnosis categorises the pathways that lead to a patient’s diagnosis of cancer. These results provide an overview of the results for 2006 to 2017, showing the trends over time for all malignant neoplasms (excluding non-melanoma skin cancer) and a snapshot of results in 2017 for female breast, colorectal, lung and prostate cancers.
• One of the aspects highlighted by Routes to Diagnosis is the inequality in how people are diagnosed. A study by Herbert and others found that age and deprivation affect the route to diagnosis. Older people continue to make up the bulk of those diagnosed as an emergency presentation, and those who are more deprived are also more likely to be diagnosed through this route.

The Use of Patient-Reported Outcome Measures to Guide Referral for Hip and Knee Arthroplasty

The Use of Patient-Reported Outcome Measures to Guide Referral for Hip and Knee Arthroplasty
Bone Joint J . 2020 Jul;102-B(7):941-949. doi: 10.1302/0301-620X.102B7.BJJ-2019-0102.R2.

• Existing UK data from 222,933 knee and 209,760 hip arthroplasty patients were used to model an individual's probability of gaining meaningful improvement after surgery based on their preoperative Oxford Knee or Hip Score (OKS/OHS). The findings are useful to support the shared decision-making process in primary care for referral to secondary care; and in secondary care for experienced clinicians counselling patients considering knee or hip arthroplasty.

Innovative use of AI and digital communication in acute stroke pathway in response to COVID-19

Innovative use of artificial intelligence and digital communication in acute stroke pathway in response to COVID-19
Future Healthcare Journal June 2020 DOI: https://doi.org/10.7861/fhj.2020-0034

• Case study of reconfiguring hyperacute stroke pathways in response to COVID-19 using artificial intelligence and digital communication support (Brainomix).

Abstract