Study of Automated Care Pathway for Patients With Chronic Obstructive Pulmonary Disease (COPD)
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Chronic Obstructive Pulmonary Disease, Pulmonary |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/16/2018 |
| Start Date: | March 26, 2018 |
| End Date: | March 2020 |
Early Patient Identification and Care Pathway for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial of Informatics Enhanced Hospital Admission
This is a fully automated randomized trial with two randomization branch-points. The first is
inclusion of disease-specific orders in the admission orders based on a predictive model
using real-time data. The second is the use of dynamic orders that are end-user tested rather
than static orders designed by a committee. The primary hypothesis is that automatic
inclusion of disease specific orders with admission orders will improve adherence to
guidelines for patients with COPD. The secondary hypothesis is that clinical and operational
outcomes will improve, thereby improving value.
inclusion of disease-specific orders in the admission orders based on a predictive model
using real-time data. The second is the use of dynamic orders that are end-user tested rather
than static orders designed by a committee. The primary hypothesis is that automatic
inclusion of disease specific orders with admission orders will improve adherence to
guidelines for patients with COPD. The secondary hypothesis is that clinical and operational
outcomes will improve, thereby improving value.
This is a single-center, single-blinded, 2x2 factorial randomized controlled trial to test
both automated order set inclusion and evidence-based order set design with end user testing
on order set use and clinical outcomes for adult patients admitted to the hospital with acute
exacerbations of Chronic Obstructive Pulmonary Disease (COPD).
First, the investigators will develop a predictive model to identify patients admitted to the
hospital with COPD exacerbations based on retrospective data, but limited to data that is
available in real-time at admission.
Second, 1,000 admissions to UCSF Medical Center of adults predicted to have COPD by the
predictive algorithm will be prospectively block randomized by encounter to automatic
inclusion of a COPD order set in the admission orders or usual care. Providers caring for
patients in both arms of the trial can independently search for and use a COPD order set. Any
provider using a COPD order set in either arm will also be randomized to see two versions of
the order set. The first is a static list of orders, and the second is dynamic, meaning that
orders will display only when appropriate. For example, a patient who just had a chest x-ray
does not need a routine repeat test. The dynamic order set will show the provider that the
x-ray was completed at a specific time and will not display a prompt for a repeat test.
Providers can, of course, still order anything they deem clinically appropriate, and may
choose to order a repeat x-ray for a patient with a change in clinical status.
The components of the order set are based on international guidelines from the Global
Initiative for Chronic Lung Disease (GOLD initiative, a collaboration between the National
Heart, Lung, and Blood Institute and the World Health Organization) and a multi-stakeholder
working group at UCSF including two hospitalists, two pulmonologists, two transitional care
nurse specialists, one advanced practice nurse, one pharmacist, one respiratory therapist,
one physical therapist, and one nurse.
both automated order set inclusion and evidence-based order set design with end user testing
on order set use and clinical outcomes for adult patients admitted to the hospital with acute
exacerbations of Chronic Obstructive Pulmonary Disease (COPD).
First, the investigators will develop a predictive model to identify patients admitted to the
hospital with COPD exacerbations based on retrospective data, but limited to data that is
available in real-time at admission.
Second, 1,000 admissions to UCSF Medical Center of adults predicted to have COPD by the
predictive algorithm will be prospectively block randomized by encounter to automatic
inclusion of a COPD order set in the admission orders or usual care. Providers caring for
patients in both arms of the trial can independently search for and use a COPD order set. Any
provider using a COPD order set in either arm will also be randomized to see two versions of
the order set. The first is a static list of orders, and the second is dynamic, meaning that
orders will display only when appropriate. For example, a patient who just had a chest x-ray
does not need a routine repeat test. The dynamic order set will show the provider that the
x-ray was completed at a specific time and will not display a prompt for a repeat test.
Providers can, of course, still order anything they deem clinically appropriate, and may
choose to order a repeat x-ray for a patient with a change in clinical status.
The components of the order set are based on international guidelines from the Global
Initiative for Chronic Lung Disease (GOLD initiative, a collaboration between the National
Heart, Lung, and Blood Institute and the World Health Organization) and a multi-stakeholder
working group at UCSF including two hospitalists, two pulmonologists, two transitional care
nurse specialists, one advanced practice nurse, one pharmacist, one respiratory therapist,
one physical therapist, and one nurse.
Inclusion Criteria:
- Patients 18 years old or greater admitted to the Hospital Medicine service at UCSF
Medical Center who meet criteria as determined by predictive model to be likely
admissions for COPD exacerbation.
Exclusion Criteria:
- Patients admitted to other clinical services at UCSF Medical Center.
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