Study of an Intervention to Improve Problem List Accuracy and Use

Not Applicable

• Conditions: Attention Deficit Disorder With Hyperactivity; Congestive Heart Failure; Glaucoma; Hemophilia; Hypertension; Myasthenia Gravis; Osteopenia; Breast Cancer; Osteoporosis; Asthma
• Interventions: Other: MAPLE

• Registration Number: NCT01105923
• Lead Sponsor: Brigham and Women's Hospital

Brief Summary

The aim of this study is to identify patients with problem list gaps and intervene to correct these gaps by creating clinical decision support interventions that alert providers to likely problem list gaps and offer clinicians the opportunity to correct them. The investigators will randomize the clinics that will receive the intervention and formally evaluate the study after a period of 6 months for improved problem list completeness to determine the effectiveness of our intervention.

Detailed Description

The clinical problem list is a cornerstone of the problem-oriented medical record. Problem lists are used in a variety of ways throughout the process of clinical care. In addition to its use by clinicians, the problem list is also critical for decision support and quality measurement.

Patients with gaps in their problem list face significant risks. For example, if a hypothetical patient has diabetes properly documented, his clinician would receive appropriate alerts and reminders to guide care. Additionally, the patient might be included in special care management programs and the quality of care provided to him would be measured and tracked. Without diabetes on his problem list, he might receive none of these benefits.

In this study, the investigators developed an clinical decision support intervention that will identify patients with problem lists gaps. The investigators will alert providers of these likely gaps and offer providers the opportunity to correct them.

Study Timeline

• Study First Submitted: 2010-04-15
• Study First Submitted QC: 2010-04-16
• Study First Posted: 2010-04-19
• Study Start: 2010-05
• Primary Completion: 2010-11
• Status Verified: 2015-01
• Last Update Submitted: 2015-01-30
• Last Update Posted: 2015-02-02
• Study Completion: 2017-11

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 140

Inclusion Criteria

• Independent healthcare provider (physician, NP, PA)
• Practices at participating site

Exclusion Criteria

• None

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Receive CDS intervention	MAPLE	Providers in clinics that will receive the CDS alert, as their clinic was randomized into our study.

Primary Outcome Measures

Name	Time	Method
Intervention acceptance	6 months (May 2010-Nov2010)	Of those providers who were shown (or who would have been shown, for the control group) the intervention, the number that added a problem across control and intervention groups.

Secondary Outcome Measures

Name	Time	Method
Problem list prevalence	pre and post intervention	Number of patients with selected problems on their problem list pre and post intervention across intervention and control groups.
Problem list incidence	pre and post intervention	For the conditions of interest, the percent of patients that had the problem added during the study period
Quality improvement based on problem list accuracy/completion	post intervention	For those with problems added due to the intervention, the number of new triggered reminders or other clinical actions.

Trial Locations

Locations (1)

Brigham and Women's Hospital; 🇺🇸 Boston, Massachusetts, United States