AHRQ EPC Series on Improving Translation of Evidence: Use of a Clinical Pathway for C. Difficile Treatment to Facilitate the Translation of Research Findings into Practice

Emilia J Flores; J Jane Jue; Gina Giradi; Karen Schoelles; Nikhil K Mull; Craig A Umscheid

doi:10.1016/j.jcjq.2019.10.002

AHRQ EPC Series on Improving Translation of Evidence: Use of a Clinical Pathway for C. Difficile Treatment to Facilitate the Translation of Research Findings into Practice

Jt Comm J Qual Patient Saf. 2019 Dec;45(12):822-828. doi: 10.1016/j.jcjq.2019.10.002. Epub 2019 Oct 28.

Authors

Emilia J Flores¹, J Jane Jue², Gina Giradi³, Karen Schoelles⁴, Nikhil K Mull⁵, Craig A Umscheid⁶

Affiliations

¹ is Penn Pathways Program Manager, Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia. Electronic address: emilia.flores@pennmedicine.upenn.edu.
² is formerly Medical Director, ECRI Guidelines Trust, ECRI Institute, is Adjunct Assistant Professor, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.
³ is Project Coordinator, ECRI Institute, Plymouth Meeting, Pennslyvania.
⁴ is Vice President, Clinical Excellence and Safety, ECRI Institute.
⁵ is Assistant Professor of Clinical Medicine, University of Pennsylvania Perelman School of Medicine, and Director, Penn Medicine Center for Evidence-based Practice.
⁶ is Chief Quality and Innovation Officer, Vice President for Healthcare Delivery Science, and Director of the Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine.

PMID: 31672660
DOI: 10.1016/j.jcjq.2019.10.002

Abstract

Background: In 2018 the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program issued a call for strategies to disseminate AHRQ EPC systematic reviews. In this pilot, findings from the 2016 AHRQ EPC report on Clostridioides difficile infection were translated into a treatment pathway and disseminated via a cloud-based platform and electronic health record (EHR).

Methods: An existing 10-step framework was used for developing and disseminating evidence-based clinical pathways. The development of the EHR intervention was informed by the Five Rights model for clinical decision support and human-computer interaction design heuristics. The researchers used observations and time measurements to describe the impact of the EPC report on pathway development and examined provider adoption using counts of pathway views.

Results: Two main themes emerged: (1) discrepancies between the EPC report and existing guidelines prompted critical discussions about available treatments, and (2) lack of guideline and pathway syntheses in the EPC report necessitated a rapid literature review. Pathway development required 340 hours: 205 for the rapid literature review, 63 for pathway development and EHR intervention design, and 5 for technical implementation of the intervention. Pathways were viewed 1,069 times through the cloud-based platform and 47 times through a hyperlink embedded in key EHR ordering screens.

Conclusion: Pathways can be an approach for disseminating AHRQ EPC report findings within health care systems; however, reports should include guideline and pathway syntheses to meet their full potential. Embedding hyperlinks to pathway content within the EHR may be a viable and low-effort solution for promoting awareness of evidence-based resources.

MeSH terms

Clostridioides difficile
Clostridium Infections / prevention & control*
Cloud Computing
Critical Pathways / organization & administration*
Critical Pathways / standards
Cross Infection / prevention & control*
Electronic Health Records / organization & administration*
Electronic Health Records / standards
Evidence-Based Practice
Pilot Projects
Quality Improvement / organization & administration*
Quality Improvement / standards
United States
United States Agency for Healthcare Research and Quality