College of Nursing Receives $1.68 Million Grant to Study Clinical Decision Support

Gail Keenan
Gail Keenan

The University of Florida College of Nursing has received a $1.68 million grant to be awarded over three years from the National Institute of Health’s National Institute of Nursing Research to fund the study titled “Tailored Clinical Decision Support Formats Designed to Improve Palliative Care for Cancer and Chronically Ill Patients: A Pre-Clinical Test.”

The project will focus on clinical decision support, an intervention approach used in the clinical setting to improve patient outcomes, and the gap in understanding of the optimal display format and its impact on palliative care end-of-life patient outcomes. Often, the care received by hospitalized end-of-life patients is not always the care that is desired, and this study aims to improve patient outcomes by ensuring the clinical decision support used by nurses provides efficient and effective support for care decisions.

Principal investigators include Gail Keenan PhD, RN, FAAN, the R. Murray and Annabel Davis Jenks Endowed Professor and chair of the Department of Family, Community and Health Systems Science; Yingwei Yao, PhD, a research associate professor; and Karen Dunn Lopez, PhD, MPH, RN, an associate professor with the University of Iowa College of Nursing.

What makes this project unique is the focus on the display format of the clinical decision support. Effective use requires the format and the content of the clinical decision support match the nurse’s ability to process and apply the information appropriately and in a timely manner. Through the electronic health record system, a well-designed clinical decision support can interpret the evidence and present suggestions about care personalized to the patient’s profile.

This project builds on a pilot simulation study of 60 nurses from a large Midwest metropolitan area that examined the impact of interactive clinical decision support prototypes using four different formats of the standard care planning features. The formats included the control, features with text, features with text and table, and features with graph.  Patient outcomes were significantly higher for those who received messages in any of the three formats that included text, table and graph compared to the control group.

This grant will support a national stratified randomized control trial to compare the effects of the three clinical decision support prototypes in a follow-up simulation study that will include a tailored condition based on the nurse’s graph literacy score. The researchers hypothesize that a tailored format will result in a faster decision time for nurses and adoption of interventions associated with better outcomes for hospitalized end-of-life patients with cancer and other chronic illnesses.

Keenan said the grant is “a significant breakthrough acknowledged by the NIH” that underscores the importance of fully testing clinical decision support before deploying these features into electronic health records.

“For too long the addition of clinical decision support to electronic health records has occurred without proper testing, which leads to numerous unintended errors from poor design and difficulty in monitoring the impact,” Keenan said. “This study not only examines the impact of varying clinical decision support formats on nurses’ decisions about palliative care but also offers the health care field a viable cost-effective model for pre-testing clinical decision support before deployment into electronic health records.”