The Patient-Centered Clinical Decision Support Learning Network (PCCDS Learning Network) is bringing together stakeholders to address the opportunities and challenges around dissemination of evidence-based findings through patient-centered clinical decision support (PCCDS). Its central focus is providing a forum for stakeholders to address opportunities and challenges around PCCDS. To this end, the Learning Network has developed an ‘Analytic Framework for Action’ to facilitate the translation of evidence (such as PCOR findings) into PCCDS for clinical practice.
The PCCDS Learning Network is promoting PCCDS, which supports care and decision-making for individual patients with information regarding PCOR findings, patient-specific data (e.g. patient-generated data and patient-reported outcomes) at the point of care between a patient, provider, and/or patient caregiver. To explore the key factors affecting PCCDS throughout its lifecycle, we developed the Analytical Framework for Action (AFA) based on iterative discussions with numerous stakeholders. The AFA has been a valuable means for identifying areas of opportunity and challenge to PCCDS, as well as a valuable conceptual tool for framing discussions with a diverse group of constituencies.
There is great potential for disseminating evidence-based findings through clinical decision support (CDS) to improve patient-centered care, healthcare quality, and a learning health system. Although CDS in general has been shown to provide discrete benefits, despite the seminal work from Wennberg and Mulley1, there has not been widespread adoption of CDS or other health technologies for promoting shared medical decision making or disseminating patient-centered outcomes research. PCCDS is a new approach to disseminating evidence-based findings (including PCOR) through CDS. However, a conceptual model of PCCDS is needed to help elucidate what PCCDS is and how it can be operationalized. To promote advances in this area, we developed a “springboard for action” to foster an ecosystem that allows all stakeholders to reduce the friction of turning knowledge from patient-centered findings into CDS-enabled actions to produce better care and outcomes. The PCCDS Analytic Framework for Action (AFA) identifies the steps in this process that must be addressed to make progress.
The AFA was developed from iterative discussions with multiple stakeholder groups that make up the Learning Network including patient advocates, provider organizations, payers, CDS content and electronic health record vendors to name a few. The final version and its key factors was approved by the Learning Network’s Steering Committee. See the defined key factors below:
- PRIORITIZING: Applying objective measures of evidence for identifying and prioritizing findings that are to be transformed and disseminated via PCCDS, assessing or defining their implementability, and defining stewardship and governance requirements.
- AUTHORING: Applying accepted data and knowledge standards for translating findings into one or more PCCDS intervention types that support key decisions, actions, and communications that are essential to ensuring that the finding improves care and outcomes.
- IMPLEMENTING: Applying standardized, best practice methods and architectures for operationalizing PCCDS interventions into clinical workflows that deliver the right information to the right user in the right format through the right channel at the right time ("CDS Five Rights").
- MEASURING: Ensuring that PCCDS interventions measurably improve clinician and patient decision-making, care processes, and outcomes.
- LEARNING: Aggregating local PCCDS-related outcomes and effectiveness measures to facilitate both local and system-level learning from identified gaps in PCOR knowledge, and lessons learned from authoring, implementing, and using PCCDS in clinical practice to enhance care and outcomes.
- EXTERNAL FACTORS: External factors including the marketplace, policy, legal, and governance issues that impact development, dissemination, and implementation processes for PCCDS.
Preliminary findings in the application of the AFAs key factors include:
- PRIORITIZING: Prioritizing evidence-based findings requires multiple stakeholders developing criteria and use cases.
- AUTHORING: Identified the need to engage stakeholders in promoting standards, methods, and tools necessary to create actionable, implementable PCCDS.
- IMPLEMENTING: Elucidated that research promotion and knowledge-sharing is needed around ways PCCDS can be and are being operationalized for people and their caregivers.
- MEASURING: The various ways that dissemination of PCCDS measurably impacts health and healthcare outcomes are observable and can be utilized to improve future care.
- LEARNING: Developing partnerships with relevant organizations such as the Patient-Centered Outcomes Research Institute (PCORI) and the Learning Health Community to translate PCCDS into a Learning Health System.
- EXTERNAL FACTORS: There is a need to provide a working definition for “PCCDS”.
The PCCDS AFA is an important conceptual framework to help guide the creation, identification, prioritization, implementation, and evaluation of PCCDS. This is a critical step in the effort toward enhancing the probability of successfully translating patient-centered findings (including PCOR) into CDS for clinical practice. The AFA was developed by a group of patient-centered, PCOR, and CDS experts in conjunction with the execution of an initial environmental scan, which provided a key initial testing environment for its applicability. Further application of the framework is warranted to evaluate its long term viability.
1Kasper JF, Mulley AG Jr, Wennberg JE. Developing shared decision-making programs to improve the quality of health care. QRB Qual Rev Bull. 1992 Jun;18(6):183-90. PubMed PMID: 1379705.
For a downloadable version of this poster presented at AMIA's iHealth in May 2017, please see link below.