Evidence Based Decision Making: Integrating Clinical Prediction Rules
NCT ID: NCT01386047
Last Updated: 2012-10-04
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
168 participants
INTERVENTIONAL
2010-08-31
2012-07-31
Brief Summary
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Detailed Description
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CPRs aid providers in assessing the impact of individual components of a patient's history, physical examination, and basic lab results to estimate probability of disease or potential response to a treatment. Prediction rules use data that is readily available at the time of a patient encounter and often reduce unnecessary treatments and diagnostic testing. CPRs differ from reminder systems or alerts in that CPRs pull in aspects of the history and physical exam and in an evidence based fashion estimate probabilities, prognosis, or make treatment recommendations.
The goal of this study is to utilize patient electronic health records to incorporate CPRs into the face-to-face patient encounter. We propose to select certain clinical situations where well-validated CPRs are available and likely to be needed on a frequent basis. We will randomly assign an integrated CPR versus usual care into the point of care and evaluate the impact of this integration on doctor behavior and evidence-based decision making. Mount Sinai's Division of General Internal Medicine (DGIM) has significant experience with all aspects of CPRs, including derivation, validation, implementation, and systematic review. Furthermore, the Division has developed an interactive web library of CPRs for clinical use that is one of the most widely sites of its kind. We propose to collaborate with Epic, one of the nation's largest and most respected electronic medical record (EMR) companies, to integrate validated CPRs into EMRs and assess the impact on provider behavior and patient care.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
HEALTH_SERVICES_RESEARCH
SINGLE
Study Groups
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iCPR randomized providers
The physician population for the proposed study will comprise primary care providers (physicians, internal medicine residents, or licensed nurse practitioners; practicing in the outpatient primary care clinics at Mount Sinai Medical Center. The iCPR tool will automatically trigger for providers randomized into the iCPR intervention arm when they initiated an encounter for a patient that meets the criteria for possible evaluation of Strep Pharyngitis or Pneumonia.
Integrated Clinical Prediction Rule (iCPR)
Integrated clinical prediction rule for Strep Pharyngitis based on Walsh clinical prediction rule (CPR) criteria and rule for Pneumonia based on Hecklering CPR criteria.
Control providers
The physician population for the proposed study will comprise primary care providers (physicians, internal medicine residents, or licensed nurse practitioners; practicing in the outpatient primary care clinics at Mount Sinai Medical Center. These providers will conduct visits for Strep Pharyngitis and Pneumonia in their manner (usual care).
No interventions assigned to this group
Interventions
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Integrated Clinical Prediction Rule (iCPR)
Integrated clinical prediction rule for Strep Pharyngitis based on Walsh clinical prediction rule (CPR) criteria and rule for Pneumonia based on Hecklering CPR criteria.
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
ALL
Yes
Sponsors
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Icahn School of Medicine at Mount Sinai
OTHER
Agency for Healthcare Research and Quality (AHRQ)
FED
Northwell Health
OTHER
Responsible Party
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Thomas McGinn
Chair and Professor for the Hofstra North Shore-LIJ School of Medicine
Principal Investigators
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Thomas M McGinn, MD, MPH
Role: PRINCIPAL_INVESTIGATOR
Northwell Health
Locations
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Mount Sinai School of Medicine
New York, New York, United States
Countries
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References
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McGinn TG, McCullagh L, Kannry J, Knaus M, Sofianou A, Wisnivesky JP, Mann DM. Efficacy of an evidence-based clinical decision support in primary care practices: a randomized clinical trial. JAMA Intern Med. 2013 Sep 23;173(17):1584-91. doi: 10.1001/jamainternmed.2013.8980.
Mann DM, Kannry JL, Edonyabo D, Li AC, Arciniega J, Stulman J, Romero L, Wisnivesky J, Adler R, McGinn TG. Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care. Implement Sci. 2011 Sep 19;6:109. doi: 10.1186/1748-5908-6-109.
Other Identifiers
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GCO-09-0337
Identifier Type: -
Identifier Source: org_study_id