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2019 HSR&D/QUERI National Conference Abstract

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4144 — Clinical Dashboard Utilization among PACT Primary Care Physicians, Nurses, and Pharmacists: Insights from a Web-based Survey

Lead/Presenter: Omar Usman,  COIN - Palo Alto
All Authors: Usman OA (VA Palo Alto Health Care System, Stanford University), Sahay, A (VA Palo Alto Health Care System), Duggal, V (VA Palo Alto Health Care System, Stanford University) Martins, S (VA Palo Alto Health Care System) Goldstein, MK (VA Palo Alto Health Care System, Stanford University)

Objectives:
Clinical dashboards are population management tools that aggregate and display relevant health data to inform patient care. Various providers use dashboards, including primary care physicians, nurses, and pharmacists. We explored the utilization of, familiarity with, and attitude toward clinical dashboards by provider type.

Methods:
We distributed a web-based survey in the Spring of 2018 to 290 providers across two medical centers in VISN 21 gauging the use of clinical dashboards among Patient-Aligned Care Teams (PACTs). We purposively-sampled three provider groups: Primary Care Providers (PCPs), nurses, and pharmacists. We used Fisher's Exact Test to detect differences among groups.

Results:
The survey response rate was 49% (n = 142) consisting of 65 PCPs (46%), 54 nurses (38%), and 23 pharmacists (16%). The response rate was similar among the three groups. Ninety-eight percent of PCPs, 100% of nurses, and 96% of pharmacists felt "somewhat comfortable" or "very comfortable" using technology, with no differences between the groups (p = 0.74). All groups were equally familiar with commonly used dashboards: the Medication Safety Dashboard (p = 0.15), Opioid Dashboard (p = 0.33), and PACT Dashboard (p = 0.14). For the PACT Dashboard, 57% found it "very useful," 38% "somewhat useful," and only 5% "not useful;" there were no differences between groups (p = 0.42). Significantly fewer PCPs used dashboards (81%) versus nurses (98%) and pharmacists (100%) (p < 0.01). However, among dashboard users, we found no difference in the use of the PACT Dashboard between PCPs (94%), nurses (86%), and pharmacists (90%) (p = 0.52). Among those who had ever used the PACT Dashboard, PCPs were more likely to have stopped using it (58%) versus nurses (31%) or pharmacists (11%) (p < 0.001). The top reasons given for abandoning the Clinical Dashboard were "time-consuming" (n = 32) and "difficult to use" (n = 16).

Implications:
PCPs, nurses, and pharmacists were all comfortable using technology, familiar with available dashboards, and found dashboards to be useful. However, PCPs used dashboards less often and stopped using dashboards more frequently. Time constraints and poor usability appear to be major factors in dashboard abandonment.

Impacts:
Dashboards are becoming increasingly popular. Understanding the utilization of, familiarity with, and attitude toward clinical dashboards can provide directed insights, inform areas for improvement, and aid in implementation.