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Adaptation and pilot implementation of a validated, electronic real time clinical decision support tool for care of Pneumonia patients in 12 Utah Urgent Care Centers

Award Number: R18HS026886
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)

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Project Summary Clinicians’ ability to accurately diagnose pneumonia and choose appropriate treatment is enhanced by well- designed clinical decision support (CDS), thereby increasing patient safety. Pneumonia CDS has historically been focused on inpatient settings, but ambulatory care settings with high pneumonia patient volumes and different care processes also need CDS. We propose to adapt and evaluate an innovative, validated electronic clinical decision support (CDS) tool based on consensus guidelines for pneumonia (ePNa) to urgent care centers (UCC). The proposal supports four aims: 1) Adapt ePNa for UCC and after in silico testing, pilot it among “super user” clinicians during UCC shifts and assess its usability. ePNa needs adaptation for the limited patient data available in UCC, calibration of severity measures for lower observed mortality, and a chest imaging prompt in patients with pneumonia signs and symptoms. ePNa for UCC will incorporate the artificial intelligence CheXpert model to provide real-time (within seconds) electronic classification of chest images for elements of pneumonia diagnosis and treatment (radiographic pneumonia, single vs multiple lobes, and pleural effusion). 2) Use the CFIR framework, a focus group of UCC clinicians, and workflow observations to identify barriers and facilitators to adaptation and implementation of ePNa to UCC. 3) Test the implementation strategy by deploying ePNa at one of two randomly chosen Intermountain Healthcare UCC clusters each with about 800 annual pneumonia patients - the other a usual care control. 4) Co-primary outcomes are a) Patients diagnosed with pneumonia without chest imaging will be =50% lower in the ePNa cluster. b) Antibiotic prescribing for treatment of pneumonia will be =90% consistent with consensus guidelines and higher in the ePNa cluster. Safety measures will be unplanned subsequent 7-day ED visits/hospitalizations and 30-day mortality. Based on this rigorous pilot study, we anticipate a subsequent multi-system cluster-randomized trial including Cerner systems outside Utah. Our work incorporates the Five Rights of CDS to ensure that the strengths of this technology are optimized in the clinical environment. We will leverage experience in innovative pneumonia research, pioneering CDS, and implementation science available at Intermountain to successfully complete this proposal. The proposal will be facilitated by and disseminated through Intermountain relationships with the PCORnet Learning Health Systems Network, PCOR CDS Learning Network, the Healthcare Services Platform Consortium, Cerner, and clinicaltrials.gov. Our innovative proposal promises to advance safety for patients suspected of pneumonia in an understudied, high-volume ambulatory care setting.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2022 ( Subtotal = $444,203 )
2022	2022	INTERMOUNTAIN HEALTH CARE, INC.	36 S STATE ST STE 1600	SALT LAKE CITY	UT	84111	SALT LAKE	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	9/15/2022	NON-COMPETING CONTINUATION	$444,203
														Subtotal = $444,203

Issue Date FY: 2021 ( Subtotal = $444,010 )
2021	2021	INTERMOUNTAIN HEALTH CARE, INC.	36 S STATE ST STE 1600	SALT LAKE CITY	UT	84111	SALT LAKE	USA	Research on Healthcare Costs, Quality and Outcomes	002	2	9/13/2021	NON-COMPETING CONTINUATION	$444,010
2021	2020	INTERMOUNTAIN HEALTH CARE, INC.	36 S STATE ST STE 1600	SALT LAKE CITY	UT	84111	SALT LAKE	USA	Research on Healthcare Costs, Quality and Outcomes	001	1	7/26/2021	NEW	$0
2021	2020	INTERMOUNTAIN HEALTH CARE, INC.	36 S STATE ST STE 1600	SALT LAKE CITY	UT	84111	SALT LAKE	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	7/6/2021	NEW	$0
														Subtotal = $444,010

Issue Date FY: 2020 ( Subtotal = $443,454 )
2020	2020	INTERMOUNTAIN HEALTH CARE, INC.	36 S STATE ST STE 1600	SALT LAKE CITY	UT	84111	SALT LAKE	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	9/23/2020	NEW	$443,454
														Subtotal = $443,454

Grand Total All Awards = $1,331,667

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Adaptation and pilot implementation of a validated, electronic real time clinical decision support tool for care of Pneumonia patients in 12 Utah Urgent Care Centers

Award Number: R18HS026886

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)

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