Healthcare-The Journal of Delivery Science and Innovation最新文献

{"title":"Leveraging Accountable Care Organization infrastructure for rapid pandemic response in independent primary care practices","authors":"Carly Amon ,&nbsp;Jennifer King ,&nbsp;Jordan Colclasure ,&nbsp;Kim Hodge ,&nbsp;C. Annette DuBard","doi":"10.1016/j.hjdsi.2022.100623","DOIUrl":"10.1016/j.hjdsi.2022.100623","url":null,"abstract":"<div><h3>Background</h3><p>Population risk segmentation and technology-enabled preventive care workflows are core competencies for Accountable Care Organizations (ACOs) that may also have relevance for public health emergencies.</p></div><div><h3>Methods</h3><p>During the early weeks of the COVID-19 pandemic, we aimed to leverage existing ACO capabilities to support 467 primary care practices across 27 states with pandemic response. We used Medicare claims and electronic health records to identify patients with increased COVID-19 vulnerability, for proactive outreach and guidance for “Staying Well at Home.”</p></div><div><h3>Results</h3><p>302,125 patients met intervention criteria; 45% were reached within the first 6 weeks. Engagement in the initiative was uneven among ACO-participating practices. ACO staff identified prior practice engagement in core ACO workflows as a major facilitator of success and staffing shortages as a major barrier. Small practice size, non-metropolitan location, penetration of value-based payment models in the practice, and pre-pandemic Annual Wellness Visit completion rates were independently associated with successful outreach to COVID-vulnerable patients.</p></div><div><h3>Conclusions</h3><p>Rapid adaptation of ACO infrastructure assisted independent practices across the country to reach vulnerable patients with proactive guidance for staying well at home. The initiative was most successful in smaller, non-metropolitan practices and those with greater engagement in core ACO initiatives pre-pandemic.</p></div><div><h3>Implications</h3><p>Our experience suggests that primary care participation in accountable care models can contribute to preparedness for future public health crises.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100623"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213076422000124/pdfft?md5=32966152c75c67d261cf28f667792f0f&pid=1-s2.0-S2213076422000124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127519585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing primary care with Artificial Intelligence and Machine Learning","authors":"Zhou Yang ,&nbsp;Christina Silcox ,&nbsp;Mark Sendak ,&nbsp;Sherri Rose ,&nbsp;David Rehkopf ,&nbsp;Robert Phillips ,&nbsp;Lars Peterson ,&nbsp;Miguel Marino ,&nbsp;John Maier ,&nbsp;Steven Lin ,&nbsp;Winston Liaw ,&nbsp;Ioannis A. Kakadiaris ,&nbsp;John Heintzman ,&nbsp;Isabella Chu ,&nbsp;Andrew Bazemore","doi":"10.1016/j.hjdsi.2021.100594","DOIUrl":"10.1016/j.hjdsi.2021.100594","url":null,"abstract":"<div><p><span><span>Primary care is the largest </span>healthcare delivery platform in the US. Facing the </span>Artificial Intelligence<span> and Machine Learning technology (AI/ML) revolution, the primary care community would benefit from a roadmap revealing priority areas and opportunities for developing and integrating AI/ML-driven clinical tools. This article presents a framework that identifies five domains for AI/ML integration in primary care to support care delivery transformation and achieve the Quintuple Aims of the healthcare system. We concluded that primary care plays a critical role in developing, introducing, implementing, and monitoring AI/ML tools in healthcare and must not be overlooked as AI/ML transforms healthcare.</span></p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100594"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39639445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of telemedicine for initial outpatient subspecialist consultative visit: A national survey of general pediatricians and pediatric subspecialists","authors":"Kristin N. Ray ,&nbsp;James C. Bohnhoff ,&nbsp;Kelsey Schweiberger ,&nbsp;Gina M. Sequeira ,&nbsp;Janel Hanmer ,&nbsp;Jeremy M. Kahn","doi":"10.1016/j.hjdsi.2021.100600","DOIUrl":"10.1016/j.hjdsi.2021.100600","url":null,"abstract":"<div><h3>Background</h3><p>Evidence-based strategies are needed to support appropriate use of telemedicine<span> for initial outpatient subspecialty consultative visits. To inform such strategies we performed a survey of general pediatricians and pediatric subspecialists about use of telemedicine for patients newly referred for pediatric subspecialty care.</span></p></div><div><h3>Methods</h3><p>We developed and fielded an e-mail and postal survey of a national sample of 840 general pediatricians and 840 pediatric subspecialists in May and June 2020.</p></div><div><h3>Results</h3><p>Of 266 completed surveys (17% response rate), 204 (76%) thought telemedicine should be offered for some and 29 (11%) thought telemedicine should be offered for all initial subspecialist visits. Most respondents who indicated telemedicine should be offered for some initial consultations believed this decision should be made by subspecialty attendings (176/204, 86%). Respondents prioritized several data elements to inform this decision, including clinical information and family-based contextual information (e.g., barriers to in-person care, interest in telemedicine, potential communication barriers). Factors perceived to reduce appropriateness of telemedicine for subspecialty consultation included need for interpreter services and prior history of frequent no-shows. Responses from generalists and subspecialists rarely differed significantly.</p></div><div><h3>Conclusions</h3><p>Survey results suggest potential opportunities to support the appropriate use of telemedicine for initial outpatient pediatric subspecialty visits through structured transfer of specific clinical and contextual information at the time of referral and through strategies to mitigate perceived communication or engagement barriers.</p></div><div><h3>Implication</h3><p>Pediatric physician beliefs about telemedicine for initial outpatient subspecialty consultative visits may inform future interventions to support appropriate telemedicine use.</p></div><div><h3>Level of evidence</h3><p>Survey of a national sample of clinicians.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100600"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10807534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of community-level social vulnerability with US acute care hospital intensive care unit capacity during COVID-19","authors":"Thomas C. Tsai ,&nbsp;Benjamin H. Jacobson ,&nbsp;E. John Orav ,&nbsp;Ashish K. Jha","doi":"10.1016/j.hjdsi.2021.100611","DOIUrl":"10.1016/j.hjdsi.2021.100611","url":null,"abstract":"<div><p>The COVID-19 pandemic has placed unprecedented stress on US acute care hospitals, leading to overburdened ICUs. It remains unknown if increased COVID-19 ICU occupancy is crowding out non-COVID-related care and whether hospitals in vulnerable communities may be more susceptible to ICUs reaching capacity. Using facility-level hospitalization data, we conducted a retrospective observational cohort study of 1753 US acute care hospitals reporting to the US Department of Health and Human Services Protect database from September 4, 2020 to February 25, 2021. 63% of hospitals reached critical ICU capacity for at least two weeks during the study period, and the surge of COVID-19 cases appeared to be crowding out non-COVID-19-related intensive care needs. Hospitals in the South (OR = 3.31, 95% CI OR 2.31–4.78) and West (OR = 2.28, 95% CI OR 1.51–3.46) were more likely to reach critical capacity than those in the Northeast, and hospitals in areas with the highest social vulnerability were more than twice as likely to reach capacity as those in the least vulnerable areas (OR = 2.15, 95% CI OR 1.41–3.29). The association between social vulnerability and critical ICU capacity highlights underlying structural inequities in health care access and provides an opportunity for policymakers to take action to prevent strained ICU capacity from compounding COVID-19 inequities.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100611"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39642803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An innovation tournament to improve medical residency","authors":"David A. Asch,&nbsp;Lisa M. Bellini,&nbsp;Sanjay V. Desai,&nbsp;Deirdre Darragh,&nbsp;Elizabeth L. Asch,&nbsp;Judy A. Shea","doi":"10.1016/j.hjdsi.2022.100614","DOIUrl":"10.1016/j.hjdsi.2022.100614","url":null,"abstract":"<div><p>Two large national studies of resident duty hours incidentally revealed surgical and medical resident dissatisfaction with residency training. Aiming for an inclusive and democratic approach to improve graduate medical education, we conducted a national innovation tournament--reaching out to the program directors of all 474 US internal medicine residency programs to invite them and their residents and associate program directors to participate. Participants could submit multiple ideas as individuals or teams in four domains: [1] resident well-being and personal and professional development; [2] resident education and clinical preparedness; [3] resident sleep and alertness; and [4] patient safety. Residents and program directors were reinvited to rate ideas, whether they had submitted ideas themselves or not. We used a schedule of lottery-based prizes to stimulate the submission and rating of ideas and encourage engagement. 164 residents and program directors from 51 different programs submitted 328 ideas. 153 residents and program directors from 48 different programs submitted 15,345 ratings of ideas. Winning ideas aimed to reduce residents’ work burden or improve their mental health, sleep, eating, or relaxation or reflected technical fixes to the operations of residency, such as changing vacation schedules and the timing of pay. The results of this tournament provided actionable suggestions to improve residency training now being tested in our own residency programs. Innovation tournaments drive engagement and generate value by their opportunities for inclusion and by shifting problem solving to the end user.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100614"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/5f/nihms-1778219.PMC8881444.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39746971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expansion of telemedicine during COVID-19 at a VA specialty clinic","authors":"Michelle D. Balut ,&nbsp;Tamar Wyte-Lake ,&nbsp;William Neil Steers ,&nbsp;Karen Chu ,&nbsp;Aram Dobalian ,&nbsp;Boback Ziaeian ,&nbsp;Leonie Heyworth ,&nbsp;Claudia Der-Martirosian","doi":"10.1016/j.hjdsi.2021.100599","DOIUrl":"10.1016/j.hjdsi.2021.100599","url":null,"abstract":"<div><h3>Background</h3><p>COVID-19 rapidly accelerated the implementation of telemedicine in U.S. Department of Veterans Affairs (VA) specialty care clinics. This mixed-methods study was conducted at a VA medical center to understand the use of telemedicine, and the barriers and facilitators to its implementation, in cardiology outpatient clinics.</p></div><div><h3>Methods</h3><p>Quantitative analyses modeled monthly trends of telemedicine use over 24-months (March 2019–March 2021) with segmented logistic regression and adjusted for socio-demographic predictors of patient-level telemedicine use. Qualitative interviews were conducted (July–October 2020) with eight cardiology clinicians.</p></div><div><h3>Results</h3><p>At the onset of COVID-19, likelihood of telemedicine use was ∼12 times higher than it was pre-COVID-19 (p &lt; 0.001). White (OR = 1.38, 95% CI:1.23–1.54), married (OR = 1.25, 95% CI:1.11–1.40), Veterans with other health insurance (OR = 1.19, 95% CI:1.06–1.35), were more likely to use telemedicine. Veterans with higher health risk factors were less likely (OR = 0.95, 95% CI:0.93–0.97). Facilitators to rapid expansion of telemedicine included prior telemedicine experience; provider trainings; and staff champions. In contrast, lack of technical support and scheduling grids for virtual visits and patient ability/preference served as barriers.</p></div><div><h3>Conclusions</h3><p>Findings suggest that once mutable barriers were addressed, the medical center was able to expand its telemedicine efforts during COVID-19. Beyond the pandemic, a hybrid of virtual and face-to-face care might be feasible and likely beneficial for healthcare providers and patients in specialty care.</p></div><div><h3>Implications</h3><p>The ability to rapidly transition from in-person to virtual visits can potentially assist with the continuity of care and management of chronic disease during infectious outbreaks and other major disasters that obstruct traditional care models.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100599"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8616735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39886327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in self-reported health: A signal for early intervention in a medicare population","authors":"Dana Drzayich Antol ,&nbsp;Angela Hagan ,&nbsp;Hannah Nguyen ,&nbsp;Yong Li ,&nbsp;Gilbert S. Haugh ,&nbsp;Michael Radmacher ,&nbsp;Kurt J. Greenlund ,&nbsp;Craig W. Thomas ,&nbsp;Andrew Renda ,&nbsp;Karen Hacker ,&nbsp;William H. Shrank","doi":"10.1016/j.hjdsi.2021.100610","DOIUrl":"10.1016/j.hjdsi.2021.100610","url":null,"abstract":"<div><h3>Background</h3><p><span>Health plans and risk-bearing provider organizations seek information sources to inform proactive interventions for patients at risk of adverse health events. Interventions should take into account the strong relationship between social context and health. This retrospective cohort study of a Medicare Advantage population examined whether a change in self-reported health-related </span>quality of life (HRQOL) signals a subsequent change in healthcare needs.</p></div><div><h3>Methods</h3><p>A retrospective longitudinal analysis of administrative claims data was conducted for participants in a Medicare Advantage plan with prescription drug coverage (MAPD) who responded to 2 administrations of the Centers for Disease Control and Prevention 4-item Healthy Days survey within 6–18 months during 2015–2018. Changes in HRQOL, as measured by the Healthy Days instrument, were compared with changes in utilization and costs, which were considered to be a reflection of change in healthcare needs.</p></div><div><h3>Results</h3><p>A total of 48,841 individuals met inclusion criteria. Declining HRQOL was followed by increases in utilization and costs. An adjusted analysis showed that every additional unhealthy day reported one year after baseline was accompanied by an $8 increase in monthly healthcare costs in the subsequent six months for the average patient.</p></div><div><h3>Conclusions</h3><p>Declining HRQOL signaled subsequent increases in healthcare needs and utilization.</p></div><div><h3>Implications</h3><p>Findings suggest that HRQOL assessments in general, and the Healthy Days instrument in particular, could serve as a leading indicator of the need for interventions designed to mitigate poor health outcomes and rising healthcare costs.</p></div><div><h3>Level of evidence</h3><p>III.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100610"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39745302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defragmenting the path to diagnosis for underserved youth with Autism Spectrum Disorder in a community-based health system","authors":"Lee A. Robinson ,&nbsp;Laura Gaugh,&nbsp;Scott Yapo,&nbsp;Rami Al-Sumairi ,&nbsp;Aileen Lorenzo ,&nbsp;Margaret Weiss","doi":"10.1016/j.hjdsi.2021.100597","DOIUrl":"10.1016/j.hjdsi.2021.100597","url":null,"abstract":"<div><p>Autism Spectrum Disorder<span><span> (ASD) is a pervasive neurodevelopmental disorder that affects about 1 out of every 54 youth and is characterized by impairments in social communication and functioning. ASD is a treatable condition though, and early initiation of interventions in the home and community can lead to improved long-term outcomes. Despite the clear benefits of early diagnosis and intervention, many youth, particularly from impoverished and minoritized populations, face tremendous barriers to accessing a timely formal diagnosis and critical early supports. Many of these barriers are inherent features of a fragmented health care system that even the most resourced of families struggle to navigate. Informed by the principles of coproduction of health care, value-based care design, and health equity, we present a quality improvement initiative to defragment the experience of care for underserved families seeking a timely formal diagnosis of ASD in a safety-net community-based </span>health system. Over the course of 2.5 years, we were able to partner with families to create clinical workflows that cut in half the duration of time from first developmental concern to ASD diagnosis, and lowered the median age of ASD diagnosis in our health system by more than 3 years. We share our process and lessons learned in the hopes of helping other health systems pursuing similar goals for patient- and family-centered care design.</span></p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100597"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39603695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to mental health support services in Accountable Care Organizations: A national survey","authors":"Susan H. Busch ,&nbsp;Marisa Tomaino ,&nbsp;Helen Newton ,&nbsp;Ellen Meara","doi":"10.1016/j.hjdsi.2022.100613","DOIUrl":"10.1016/j.hjdsi.2022.100613","url":null,"abstract":"<div><p>Patients with serious mental illness often lack access to mental health support services. Whether new payment models facilitate access to these services is unknown. We conducted a national survey of accountable care organizations(ACOs) and find that fewer than 50% of ACOs surveyed reported that they have the ability to offer or refer patients to supported employment, family psychoeducation<span>, assertive community treatment and illness, management and recovery services. These findings suggest that even among organizations that are early adopters of payment and delivery reforms -- those most likely to lead innovations in population health -- access to these services is limited.</span></p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100613"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9358466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments","authors":"Gwen Costa Jacobsohn PhD MA ,&nbsp;Margaret Leaf MS ,&nbsp;Frank Liao PhD ,&nbsp;Apoorva P. Maru BS ,&nbsp;Collin J. Engstrom PhD MS ,&nbsp;Megan E. Salwei PhD ,&nbsp;Gerald T. Pankratz MD ,&nbsp;Alexis Eastman MD ,&nbsp;Pascale Carayon PhD ,&nbsp;Douglas A. Wiegmann PhD MS ,&nbsp;Joel S. Galang MS ,&nbsp;Maureen A. Smith MD PhD MPH ,&nbsp;Manish N. Shah MD MPH ,&nbsp;Brian W. Patterson MD MPH","doi":"10.1016/j.hjdsi.2021.100598","DOIUrl":"10.1016/j.hjdsi.2021.100598","url":null,"abstract":"<div><p>Of the 3 million older adults seeking fall-related emergency care each year, nearly one-third visited the Emergency Department<span> (ED) in the previous 6 months. ED providers have a great opportunity to refer patients for fall prevention services at these initial visits, but lack feasible tools for identifying those at highest-risk. Existing fall screening tools have been poorly adopted due to ED staff/provider burden and lack of workflow integration. To address this, we developed an automated clinical decision support (CDS) system for identifying and referring older adult ED patients at risk of future falls.</span></p><p>We engaged an interdisciplinary design team (ED providers, health services researchers, information technology/predictive analytics professionals, and outpatient Falls Clinic staff) to collaboratively develop a system that successfully met user requirements and integrated seamlessly into existing ED workflows. Our rapid-cycle development and evaluation process employed a novel combination of human-centered design, implementation science, and patient experience strategies, facilitating simultaneous design of the CDS<span> tool and intervention implementation strategies. This included defining system requirements, systematically identifying and resolving usability problems, assessing barriers and facilitators to implementation (e.g., data accessibility, lack of time, high patient volumes, appointment availability) from multiple vantage points, and refining protocols for communicating with referred patients at discharge. ED physician, nurse, and patient stakeholders were also engaged through online surveys and user testing.</span></p><p>Successful CDS design and implementation required integration of multiple new technologies and processes into existing workflows, necessitating interdisciplinary collaboration from the onset. By using this iterative approach, we were able to design and implement an intervention meeting all project goals. Processes used in this Clinical-IT-Research partnership can be applied to other use cases involving automated risk-stratification, CDS development, and EHR-facilitated care coordination.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100598"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10807545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}