Document Detail


Development of an electronic medical record-based clinical decision support tool to improve HIV symptom management.
MedLine Citation:
PMID:  19538046     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Common symptoms associated with HIV disease and its management are often underrecognized and undertreated. A clinical decision support tool for symptom management was developed within the Veterans Health Administration electronic medical record (EMR), aiming at increasing provider awareness of and response to common HIV symptoms. Its feasibility was studied in March to May 2007 by implementing it within a weekly HIV clinic, comparing a 4-week intervention period with a 4-week control period. Fifty-six patients and their providers participated in the study. Patients' perceptions of providers' awareness of their symptoms, proportion of progress notes mentioning any symptom(s) and proportion of care plans mentioning any symptom(s) were measured. The clinical decision support tool used portable electronic "tablets" to elicit symptom information at the time of check-in, filtered, and organized that information into a concise and clinically relevant EMR note available at the point of care, and facilitated clinical responses to that information. It appeared to be well accepted by patients and providers and did not substantially impact workflow. Although this pilot study was not powered to detect effectiveness, 25 (93%) patients in the intervention group reported that their providers were very aware of their symptoms versus 27 (75%) control patients (p = 0.07). The proportion of providers' notes listing symptoms was similar in both periods; however, there was a trend toward including a greater number of symptoms in intervention period progress notes. The symptom support tool seemed to be useful in clinical HIV care. The Veterans Health Administration EMR may be an effective "laboratory" for developing and testing decision supports.
Authors:
Claudia M Nader; Joel Tsevat; Amy C Justice; Joseph M Mrus; Forrest Levin; Michael J Kozal; Kristin Mattocks; Steven Farber; Michelle Rogers; Joseph Erdos; Cynthia Brandt; Ian Kudel; Ronald Braithwaite
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  AIDS patient care and STDs     Volume:  23     ISSN:  1557-7449     ISO Abbreviation:  AIDS Patient Care STDS     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-22     Completed Date:  2009-10-01     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  9607225     Medline TA:  AIDS Patient Care STDS     Country:  United States    
Other Details:
Languages:  eng     Pagination:  521-9     Citation Subset:  IM; X    
Affiliation:
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA. clnader@bu.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Decision Making, Computer-Assisted
Decision Support Systems, Clinical / instrumentation*
Female
HIV Infections / diagnosis*,  drug therapy
Humans
Male
Medical Records Systems, Computerized / instrumentation*
Middle Aged
Patient Satisfaction
Physician's Practice Patterns
Pilot Projects
Practice Guidelines as Topic
Questionnaires
Severity of Illness Index*
United States
United States Department of Veterans Affairs
Grant Support
ID/Acronym/Agency:
U10 AA013566-08/AA/NIAAA NIH HHS
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