Lessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary care
Abstract Background Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) was a pragmatic, cluster randomized trial assessing the effectiveness of a clinical decision support (CDS) tool in primary care, Nova Scotia, Canada. We evaluated if CDS software versus...
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doaj-568d4fc0a09644a6b6b5b4bbb3f9f45c2021-08-15T11:36:20ZengBMCTrials1745-62152021-08-012211910.1186/s13063-021-05488-yLessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary careJoanna M. Nemis-White0Laura M. Hamilton1Sarah Shaw2James H. MacKillop3Ratika Parkash4Shurjeel H. Choudhri5Antonio Ciaccia6Feng Xie7Lehana Thabane8Jafna L. Cox9for the IMPACT-AF InvestigatorsPrincipal, Strive Health Management Consulting Ltd.Research Manager, QEII Health Sciences Centre, Nova Scotia Health AuthorityHealthy Communities Program Officer, Public Health, Nova Scotia Health AuthorityFamily Physician, Sydney Primary Care Medical ClinicDivision of Cardiology, Department of Medicine, Dalhousie UniversitySenior Vice President and Head, Medical & Scientific Affairs, Bayer IncDirector & Head, Medical Affairs – Cardiovascular Medicine, Bayer IncProfessor, Department of Health Research Methods, Evidence, and Impact, McMaster UniversityProfessor, Department of Health Research Methods, Evidence, and Impact, McMaster UniversityDivision of Cardiology, Department of Medicine, Dalhousie UniversityAbstract Background Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) was a pragmatic, cluster randomized trial assessing the effectiveness of a clinical decision support (CDS) tool in primary care, Nova Scotia, Canada. We evaluated if CDS software versus Usual Care could help primary care providers (PCPs) deliver individualized guideline-based AF patient care. Methods Key study challenges including CDS development and implementation, recruitment, and data integration documented over the trial duration are presented as lessons learned. Results Adequate resources must be allocated for software development, updates and feasibility testing. Development took longer than projected. End-user feedback suggested network access and broadband speeds impeded uptake; they felt further that the CDS was not sufficiently user-friendly or efficient in supporting AF care (i.e., repetitive alerts). Integration across e-platforms is crucial. Intellectual property and other issues prohibited CDS integration within electronic medical records and provincial e-health platforms. Double login and data entry were impediments to participation or reasons for provider withdrawal. Data integration challenges prevented easy and timely data access, analysis, and reporting. Primary care study recruitment is resource intensive. Altogether, 203 PCPs and 1145 of their patients participated, representing 25% of eligible providers and 12% of AF patients in Nova Scotia, respectively. The most effective provider recruitment strategy was in-office, small group lunch-and-learns. PCPs with past research experience or who led patient consent were top recruiters. The study office played a pivotal role in achieving patient recruitment targets. Conclusions A rapid growth in healthcare data is leading to widespread development of CDS. Our experience found practical issues to address for such applications to succeed. Feasibility testing to assess the utility of any healthcare CDS prior to implementation is recommended. Adequate resources are necessary to support successful recruitment for future pragmatic trials. CDS tools that integrate multiple co-morbid guidelines across eHealth platforms should be pursued. Trial registration ClinicalTrials.gov NCT01927367. Registered on August 22, 2013https://doi.org/10.1186/s13063-021-05488-yAtrial fibrillationClinical trialsInformaticsClinical decision support |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Joanna M. Nemis-White Laura M. Hamilton Sarah Shaw James H. MacKillop Ratika Parkash Shurjeel H. Choudhri Antonio Ciaccia Feng Xie Lehana Thabane Jafna L. Cox for the IMPACT-AF Investigators |
spellingShingle |
Joanna M. Nemis-White Laura M. Hamilton Sarah Shaw James H. MacKillop Ratika Parkash Shurjeel H. Choudhri Antonio Ciaccia Feng Xie Lehana Thabane Jafna L. Cox for the IMPACT-AF Investigators Lessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary care Trials Atrial fibrillation Clinical trials Informatics Clinical decision support |
author_facet |
Joanna M. Nemis-White Laura M. Hamilton Sarah Shaw James H. MacKillop Ratika Parkash Shurjeel H. Choudhri Antonio Ciaccia Feng Xie Lehana Thabane Jafna L. Cox for the IMPACT-AF Investigators |
author_sort |
Joanna M. Nemis-White |
title |
Lessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary care |
title_short |
Lessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary care |
title_full |
Lessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary care |
title_fullStr |
Lessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary care |
title_full_unstemmed |
Lessons learned from Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF): a pragmatic clinical trial of computerized decision support in primary care |
title_sort |
lessons learned from integrated management program advancing community treatment of atrial fibrillation (impact-af): a pragmatic clinical trial of computerized decision support in primary care |
publisher |
BMC |
series |
Trials |
issn |
1745-6215 |
publishDate |
2021-08-01 |
description |
Abstract Background Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) was a pragmatic, cluster randomized trial assessing the effectiveness of a clinical decision support (CDS) tool in primary care, Nova Scotia, Canada. We evaluated if CDS software versus Usual Care could help primary care providers (PCPs) deliver individualized guideline-based AF patient care. Methods Key study challenges including CDS development and implementation, recruitment, and data integration documented over the trial duration are presented as lessons learned. Results Adequate resources must be allocated for software development, updates and feasibility testing. Development took longer than projected. End-user feedback suggested network access and broadband speeds impeded uptake; they felt further that the CDS was not sufficiently user-friendly or efficient in supporting AF care (i.e., repetitive alerts). Integration across e-platforms is crucial. Intellectual property and other issues prohibited CDS integration within electronic medical records and provincial e-health platforms. Double login and data entry were impediments to participation or reasons for provider withdrawal. Data integration challenges prevented easy and timely data access, analysis, and reporting. Primary care study recruitment is resource intensive. Altogether, 203 PCPs and 1145 of their patients participated, representing 25% of eligible providers and 12% of AF patients in Nova Scotia, respectively. The most effective provider recruitment strategy was in-office, small group lunch-and-learns. PCPs with past research experience or who led patient consent were top recruiters. The study office played a pivotal role in achieving patient recruitment targets. Conclusions A rapid growth in healthcare data is leading to widespread development of CDS. Our experience found practical issues to address for such applications to succeed. Feasibility testing to assess the utility of any healthcare CDS prior to implementation is recommended. Adequate resources are necessary to support successful recruitment for future pragmatic trials. CDS tools that integrate multiple co-morbid guidelines across eHealth platforms should be pursued. Trial registration ClinicalTrials.gov NCT01927367. Registered on August 22, 2013 |
topic |
Atrial fibrillation Clinical trials Informatics Clinical decision support |
url |
https://doi.org/10.1186/s13063-021-05488-y |
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