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IIR 02-097 – HSR&D Study

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IIR 02-097
Meta-Analysis of the Efficacy of Computer-based Feedback Implementations
Charlene Raye Weir PhD RN
VA Salt Lake City Health Care System, Salt Lake City, UT
Salt Lake City, UT
Funding Period: January 2004 - December 2006

BACKGROUND/RATIONALE:
Many recent reviews of the impact of Information Technology in healthcare have found the literature lacks sufficient specification of contextual and moderating variables to produce generalizable results. The purpose of this study was to conduct a systematic review of the literature of computerized interventions exploring two classes of theoretical variables to the pattern: 1) the intensity of social influence and; 2) the degree of task uncertainty.

OBJECTIVE(S):
I. Determine the overall averaged effect of computerized interventions on: a) patient outcomes, b) provider adoption and c) economic outcomes.
II. Determine the evidence that characteristics of social influence and/or task uncertainty directly or in interaction moderate the relationship between computerized interventions and: a) patient outcomes, b) provider adoption and c) economic outcomes.

METHODS:
Systematic standard procedures were used to develop a search strategy and relevance criteria. Multiple databases (Medline, CINAHL, Cochrane, PsychInfo, DARE, INSPEC, and EMBASE) were searched from 1976 through the end of 2005. The search criteria included all forms of computer*, alerts, reminders, decision-support, outcome and evaluation studies as well as English-only. Articles were judged relevant if they reported an intervention that occurred in a real clinical environment targeted at clinicians. References for articles published after 1990 were reviewed and authors contacted. The topic areas of Computerized Provider Order Entry, Lifestyle Counseling and Infectious Disease prevention and treatment were individually addressed. Research quality was assessed using an instrument developed for this study (QUASII). Coding protocols were developed, tested and utilized to assess: 1) the intensity of social influence (mandated use, role congruence, imbedded into workflow, and feedback related to performance assessment) and; 2) the degree of task uncertainty (complexity of decision, prevalence and/or frequency of decision, and ease of compliance).

FINDINGS/RESULTS:
The overall search yielded 63,731 references with 2,023 abstracts rated as meeting relevance criteria. CPOE: Thirty-two CPOE articles meeting the relevance criteria were extracted and reviewed. The Q test for heterogeneity was highly significant (X2 = 95.21; df=31) and the quality scores were very low, so no attempt was made to aggregate effects. The most significant quality problem was the lack of construct validity across studies. No two studies had comparable interventions, severely limiting generalizability. Across the entire literature, there was a failure to delineate relationships between variables and a limited number of dependent variables. Poor designs and measurement techniques were also prevalent. INFECTIOUS DISEASE: Forty-one articles meeting the relevance criteria were extracted and reviewed. The Q test for heterogeneity was highly significant (X2 = 102.34; df=40). Intensity of social influence and task uncertainty interacted such that social influence factors had more impact in studies with low uncertainty tasks (e.g. preventative care measures). Significant variance existed across studies after this analysis.

IMPACT:
Effective implementation of alerts/reminders and other computerized interventions may depend on having a match between the implementation strategies and the type of decision task being supported.



PUBLICATIONS:

Journal Articles

  1. Weir CR, Staggers N, Laukert T. Reviewing the impact of computerized provider order entry on clinical outcomes: The quality of systematic reviews. International journal of medical informatics. 2012 Apr 1; 81(4):219-31.
  2. Weir CR, Staggers N, Phansalkar S. The state of the evidence for computerized provider order entry: a systematic review and analysis of the quality of the literature. International journal of medical informatics. 2009 Jun 1; 78(6):365-74.
  3. Weir CR, McCarthy CA. Using implementation safety indicators for CPOE implementation. Joint Commission Journal on Quality and Patient Safety. 2009 Jan 1; 35(1):21-8.
  4. Phansalkar S, Weir CR, Morris AH, Warner HR. Clinicians' perceptions about use of computerized protocols: a multicenter study. International journal of medical informatics. 2008 Mar 1; 77(3):184-93.
  5. Phansalkar S, Sward KA, Weir CR, Morris AH. Mapping clinicians' perceptions about computerized protocol use to an IT implementation framework. Studies in health technology and informatics. 2007 Oct 1; 129(Pt 2):1098-101.
  6. Weir CR, Nebeker JJ, Hicken BL, Campo R, Drews F, Lebar B. A cognitive task analysis of information management strategies in a computerized provider order entry environment. Journal of the American Medical Informatics Association : JAMIA. 2007 Jan 1; 14(1):65-75.
  7. Weir CR, Hicken BL, Rappaport HS, Nebeker JR. Crossing the quality chasm: the role of information technology departments. American journal of medical quality : the official journal of the American College of Medical Quality. 2006 Nov 1; 21(6):382-93.
Reports

  1. Staggers, Weir, Phansalker. Evidence for Nursing Practice Impacts of Integrative Functions in Electronic Health Records. Rockville, MD: AHRQ Publication; 2008 Apr 1. Report No.: 08-0043.
VA Cyberseminars

  1. Weir. Information Overload and Design and Implementation of Computerized Decision Support. [Cyberseminar]. 2008 May 10.
Conference Presentations

  1. LaFleur J, Ginter T, Hayden C, DuVall SL, Nebeker JR. Bone Mineral Density Screening and Osteoperosis rates in veterans. Poster session presented at: American Society for Bone and Mineral Research Annual Meeting; 2011 Sep 18; San Diego, CA.
  2. Weir CR. Critical Concepts in Human-Computer Interactions. Presented at: University of Utah Biomedical Informatics Research Monthly Seminar; 2008 Nov 1; Salt Lake City, UT.
  3. Weir. A test of Dual-Process Cognitive Theories in Modeling Variation of in a Meta-Analysis of Computerized Interventions. Presented at: VA HSR&D National Meeting; 2008 Feb 1; Baltimore, MD.
  4. Weir, Nebeker. Predictors of Physician's Intention to Investigate Adverse Drug Events. Presented at: VA HSR&D National Meeting; 2008 Feb 1; Baltimore, MD.
  5. Weir. The Role of Intrinsic Motivation in Provider Competence in Caring for End-of-Life Patients. Presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA.
  6. Weir, Nebeker, Rappaport. Perceived threats to Safety Using Electronic Documentation. Presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA.


DRA: Health Systems
DRE: none
Keywords: Behavior (provider), Decision support, Quality assurance, improvement
MeSH Terms: none

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