JMIR Publications

ABSTRACT

Background:

Studies evaluating strategies for the rapid development, implementation and evaluation of clinical decision support(CDS) systems supporting guidelines for diseases with poor knowledge base, such as COVID-19, are limited.

Objective:

We developed an anticoagulation clinical practice consensus guideline(CPG) for COVID-19 delivered and scaled via CDS across a 12-hospital Midwest healthcare system. This study represents a pre-planned 6-month post-implementation evaluation guided by the RE-AIM framework.

Methods:

Implementation outcomes evaluated include reach, adoption, implementation, and maintenance. To evaluate effectiveness, the association of CPG adherence was assessed using multivariable logistic regression. The primary effectiveness endpoint was the need for ICU admission within 48 hours of hospital admission.

Results:

2,503 patients were included in this study. CDS reach approached 95% during implementation. Adherence achieved a peak of 72% during implementation. Variation was noted in adoption across sites and nursing units. Adoption was best at COVID-19 cohorted hospitals(74-82%) and lowest at academic settings(47-55%). CPG delivery via CDS was associated with improved adherence (OR 1.43, 95%CI 1.2-1.7, p<0.001). Adherence with the anticoagulation CPG was associated with a significant reduction in the need for ICU within 48 hours (OR 0.39, 95%CI 0.30–0.51, p<0.001).

Conclusions:

Our institutional experience demonstrated that adherence with institutional CPG delivered via CDS resulted in improved clinical outcomes for patients with COVID-19. CDS are an effective means to rapidly scale a CPG across a heterogeneous healthcare system. Further research is needed to investigate factors associated with adherence at low and high adopting sites and nursing units.