Integrating Contextual Factors into Clinical Decision Support to Reduce Contextual Error and Improve Outcomes in Ambulatory Care (Illinois)

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Project Details - Ongoing


Effective care planning must take into account patient context, or the particular circumstance and behaviors of the patient. Contextual errors occur when a care plan is inappropriate because of inattention to patient context. For example, increasing the dosage of a patient’s medication to manage deterioration of a chronic condition is a contextual error when the disease symptoms are due to something in a patient’s circumstances, such as a change in health insurance coverage, loss of social support, or competing responsibilities. Contextual errors can lead to diminished healthcare outcomes and an increase in healthcare costs related to overuse and misuse of medical services.

Contextual errors can be avoided by contextualizing care, a four-step process previously developed by the project team. In the first step, the clinician identifies clues of unresolved challenges in their patient’s health or healthcare that could be attributed to circumstances in their life situation, called contextual red flags. The second step is asking relevant questions, termed contextual probes, to identify the potential cause. The third step is assessing whether the information elicited is pertinent to the unresolved challenges, called contextual factors. Finally, the fourth step is arriving at a contextualized plan of care that addresses the identified contextual factors.

While clinical decision support (CDS) has been used to provide physicians with timely biomedical information at the point of care to prevent errors and promote appropriate care, it has not been used to alert physicians to both contextual red flags and contextual factors to avoid these errors. This project will explore whether providing clinicians with contextual information at the point of care through the use of CDS in the electronic medical record (EMR) can reduce these errors, improve patient health care outcomes, and reduce misuse and overuse of medical services.

The specific aim of the project is as follows:

  • Design and implement contextualized CDS, which will then be assessed through a randomized controlled intervention trial. 

In the first phase of the study, the team will design and introduce a CDS intervention informed by contextual information provided by patients through a web portal, as well as from the EMR. In the second phase, both real and unannounced standardized patients will be randomized to receive care either with or without enhanced contextualized CDS and followed for 4-6 months after their index visit for assessment of outcomes and costs of care.

This project will translate current understanding of contextual errors into a set of design principles for an innovative “contextualized CDS” application. This CDS application has the potential to improve outpatient care through timely, situated alerts for delivering care that is aligned with needs of the patient.