Project Details - Ended
- Grant Number:K08 HS021271
- Funding Mechanism:
- AHRQ Funded Amount:$773,120
- Principal Investigator:
- Project Dates:5/9/2013 to 4/30/2018
- Care Setting:
- Medical Condition:
- Type of Care:
- Health Care Theme:
Imaging is the fastest growing healthcare expenditure in the United States, increasing twice as fast as total healthcare costs. Clinical decision support (CDS) tools have been developed to minimize costs and make safe decisions regarding imaging at the bedside. While clinically helpful, health information technology can hinder the clinician-patient relationship. The development of patient-centered CDS tools is needed to promote evidence-based decisions for mild traumatic brain injury patient imaging.
This project developed and validated the Concussion or Brain Bleed application (app), an innovative CDS tool that integrated a patient-centered decision aid and CDS at the bedside for the management of minor head injury in the emergency department (ED). This project aimed to shift paradigms for CDS and the ED patient encounter by bringing CDS to the point-of-care for shared use by the patient and provider. The app was based on the Canadian Computed Tomography (CT) Head Rule (CCTHR), a CDS tool designed and validated to safely reduce imaging in minor head injury.
The specific aims of the project were to:
- Identify nonclinical, human factors that promote or inhibit the appropriate use of CT in patients presenting to the ED with minor head injury.
- Evaluate an CDS app that helps clinicians determine the need for CT use based on the CCTHR in a patient-centered and evidence-based manner.
- Describe the use of the Concussion or Brain Bleed app in a high-volume ED.
Researchers conducted focus groups with patients and semi-structured interviews with providers to inform the iterative design and development of the Concussion or Brain Bleed app. The study team then led a prospective pilot study with 41 ED patients. Patients and clinicians used the app and completed a survey to determine baseline efficacy on patient experience, clinician experience, health care utilization, and patient safety. In patients with low-risk minor head injury who were being considered for CT head imaging in the ED, use of the Concussion or Brain Bleed app resulted in increased patient knowledge and was associated with a low rate of CT use, high trust in the physician, low patient decisional conflict, high clinician Net Promoter Score, and high system usability score without any adverse events in patients. Investigators recommend that future research focus on assessing and optimizing the implementation of the app into routine ED care.