ePneumonia: Development of an Electronic Clinical Decision Support System for Community-Onset Pneumonia

NCT ID: NCT03358342

Last Updated: 2020-10-08

Study Results

Results pending

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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Recruitment Status

COMPLETED

Total Enrollment

10000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-11-22

Study Completion Date

2019-12-31

Brief Summary

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The investigators plan to further develop a prototype, evidence-based, electronic clinical decision support system (CDSS) for pneumonia care (ePneumonia) with interoperability across Electronic Health Records in order to improve clinical outcomes and reduce healthcare resource utilization. The specific aims of this study are to evaluate the usability of ePneumonia adapted for Cerner and its impact on clinical, patient-centered and healthcare resource utilization outcomes in a stepped-wedge implementation study in 16 hospital emergency departments (EDs) across the Intermountain Healthcare integrated health system.

Detailed Description

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Since the launch of a paper-based pneumonia care process model in 1994, decision support for pneumonia care has been under continuous development at Intermountain. Studies published in 2001 and 2006 demonstrated decreased mortality using paper-based methods. An electronic pneumonia Clinical Decision Support System was later developed in the original Intermountain computing environment and implemented in 4 regional emergency departments (ED) in 2011. This tool featured a novel mortality predictor and real-time synthesis of clinical data to guide diagnosis, risk stratification, admission triage and guideline-concordant treatment. An outcome study published in 2015 demonstrated reduction in mortality with tool use compared to usual care. Most recently, Intermountain researchers led by study co-Investigator, Dr. Brandon Webb, developed an innovative tool to predict risk of drug-resistant bacteria and demonstrated its potential to improve antibiotic use and outcomes.

The investigators have entered a robust phase of additional development and adaptation of ePneumonia into the Cerner Electronic Health Record (EHR) system. The objective of this study is to advance development of an evidence-based, electronic CDSS for pneumonia care with interoperability across EHRs in order to improve clinical outcomes and reduce healthcare resource utilization. The specific aim of this study is to evaluate the usability of ePneumonia and its associated impact on clinical, patient-centered and healthcare resource utilization outcomes in a stepped-wedge implementation study in 16 hospital EDs in the Intermountain Healthcare integrated health system.

* Hypothesis #1: Healthcare providers will affirm ePneumonia usability, lack of interference with clinical workflow and only minor unintended consequences of use.
* Hypothesis #2: In patients with community-onset pneumonia, ePneumonia use will improve clinical and patient-centered outcomes and decrease healthcare resource utilization.

One year of baseline clinical outcome data will be gathered for all 16 emergency departments. The first of 6 clusters of ED's will begin prospective data collection in January 2018, with the remaining coming on at 2 month intervals until ePneumonia has been deployed at all sites. An additional 1 year of data collection will be continued through 2019.

Conditions

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Pneumonia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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ED Patients treated using ePneumonia CDS

ED patients with community-acquired pneumonia treated in ED's after roll out of ePneumonia

ePneumonia CDS

Intervention Type OTHER

ePneumonia clinical decision support system for community-onset pneumonia

Usual care

ED patients with pneumonia receiving usual care without electronic CDS

No interventions assigned to this group

Interventions

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ePneumonia CDS

ePneumonia clinical decision support system for community-onset pneumonia

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* All patients ≥ 18 years who are identified by either (2a) ICD-10 codes for pneumonia; or acute respiratory failure or sepsis with secondary pneumonia codes or (2b) clinician completion of ePneumonia for Cerner.
* Intermountain Healthcare physicians working in the 16 ED's

Exclusion Criteria

* Patients without radiographic confirmation of pneumonia
* subsequent episodes of pneumonia within the study period, so as not to over-represent patients with recurrent pneumonia caused by recurrent aspiration or structural lung disease, and
* immunosuppressed patients, such as those with AIDS.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Intermountain Health Care, Inc.

OTHER

Sponsor Role lead

Responsible Party

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Nathan Dean

Section Chief of Pulmonary and Critical Care Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nathan Dean, MD

Role: PRINCIPAL_INVESTIGATOR

Intermountain Health Care, Inc.

Locations

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Cassia Regional Hospital

Burley, Idaho, United States

Site Status

American Fork Hospital

American Fork, Utah, United States

Site Status

Cedar City Hospital

Cedar City, Utah, United States

Site Status

Delta Community Hospital

Delta, Utah, United States

Site Status

Fillmore Hospital

Fillmore, Utah, United States

Site Status

Heber Valley Hospital

Heber City, Utah, United States

Site Status

Logan Regional Hospital

Logan, Utah, United States

Site Status

Sanpete Valley Hospital

Mount Pleasant, Utah, United States

Site Status

Intermountain Medical Center

Murray, Utah, United States

Site Status

McKay-Dee Hospital

Ogden, Utah, United States

Site Status

Orem Community Hospital

Orem, Utah, United States

Site Status

Garfield Memorial Hospital

Panguitch, Utah, United States

Site Status

Park City Medical Center

Park City, Utah, United States

Site Status

Utah Valley Hospital

Provo, Utah, United States

Site Status

Sevier Valley Hospital

Richfield, Utah, United States

Site Status

Dixie Regional Medical Center

St. George, Utah, United States

Site Status

Bear River Hospital

Tremonton, Utah, United States

Site Status

Countries

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United States

References

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Dean NC, Vines CG, Carr JR, Rubin JG, Webb BJ, Jacobs JR, Butler AM, Lee J, Jephson AR, Jenson N, Walker M, Brown SM, Irvin JA, Lungren MP, Allen TL. A Pragmatic, Stepped-Wedge, Cluster-controlled Clinical Trial of Real-Time Pneumonia Clinical Decision Support. Am J Respir Crit Care Med. 2022 Jun 1;205(11):1330-1336. doi: 10.1164/rccm.202109-2092OC.

Reference Type DERIVED
PMID: 35258444 (View on PubMed)

Other Identifiers

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ePneumonia - CDS

Identifier Type: -

Identifier Source: org_study_id

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