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Enabling Shared Decision Making to Reduce Harm from Drug Interactions: An End-to-End Demonstration
Project Final Report (PDF, 1.27 MB) Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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Use of DDInteract resulted in patients favoring pain treatments with less risk of gastrointestinal bleeding, with this tool having broad applicability to other therapeutic interventions that would benefit from this model of SDM.
Project Details -
Completed
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Grant NumberU18 HS027099
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AHRQ Funded Amount$995,341
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Principal Investigator(s)
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Organization
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LocationSalt Lake CityUtah
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Project Dates09/30/2019 - 09/29/2021
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Technology
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Care Setting
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Medical Condition
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Health Care Theme
While drug-drug interactions (DDIs) are preventable, they still account for 5 to 14 percent of adverse drug reactions (ADRs) in hospitalized patients and up to 13 percent of elderly ambulatory patients. Adoption of clinical decision support (CDS) tools that use DDI drug checking has not solved the issue, with alerts often overridden by providers. Although patients could play a role in preventing harm due to DDIs, they are not currently engaged in shared decision making (SDM) around risks.
This research moved beyond physician-centric decision making to patient-centered SDM by creating a dashboard that graphically communicates risks and decision options. The research team designed and assessed usability of this DDI tool, DDInteract, for SDM around risk of gastrointestinal (GI) bleeding with the DDI between warfarin and nonsteroidal anti-inflammatory drugs.
The specific aims of the research were as follows:
- Design and evaluate a user centered DDI CDS dashboard called DDInteract.
- Enable the creation of contextual DDI CDS knowledge artifacts using CDS Connect.
- Conduct a pilot dissemination of DDInteract and DDI knowledge process.
DDInteract includes a patient-specific risk profile, patient education information, and a treatment decision tree. It uses SMART on FHIR standards, making it vendor-agnostic and interoperable. Applying user-centered design principles, the tool was designed, tested, and evaluated using physician-patient pairs and a simulated encounter. The dyads were randomized to either the use of the tool or usual care. Four patients 65-85 years old who had been on warfarin for more than 5 years, as well as 11 clinicians participated in the evaluation. DDInteract was positively received by both patients and physicians, with patients favoring pain treatments with less risk of GI bleeding.
The researchers also designed extensions for the CDS Connect Authoring Tool. This tool is an interface that allows users to create CDS logic that is exported as FHIR standards, allowing them to be adopted by others. Using CDS Hooks, these new extensions allowed a CDS author to specify where in an electronic health record (EHR) DDI’s CDS rules could be integrated, specifically the medication ordering, patient-view, order-select, and order-review hooks. CDS Hooks is an HL7 specification that specifies how to embed CDS functionality within the EHR, allowing others to more efficiently and effectively incorporate CDS into their EHRs. The researchers plan to further evaluate DDInteract to better understand how the tool impacts decision making, satisfaction, and clinician workflow.
Disclaimer
Disclaimer details
Citation:
Gomez Lumbreras A, Reese TJ, Del Fiol G, Tan MS, Butler JM, Hurwitz JT, Brown M, Kawamoto K, Thiess H, Wright M, Malone DC. Shared decision-making for drug-drug interactions: Formative evaluation of an anticoagulant drug interaction. JMIR Form Res. 2022 Oct 19;6(10):e40018. doi: 10.2196/40018. PMID: 36260377; PMCID: PMC9631167.
Principal Investigator:
Malone, Daniel C.
Project Name:
Enabling Shared Decision Making to Reduce Harm from Drug Interactions: An End-to-End Demonstration
Document Type:
Journal Publication
Research Method:
Interview, Mixed Methods, Randomized Controlled Trial (RCT), Survey
Technology:
Clinical Decision Support System
Citation:
Malone D. Enabling Shared Decision Making to Reduce Harm from Drug Interactions: An End-to-End Demonstration - Final Report. (Prepared by the University of Utah under Grant No. U18 HS027099). Rockville, MD: Agency for Healthcare Research and Quality, 2022.
Link:
PDF (1.27 MB)
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator:
Malone, Daniel C.
Project Name:
Enabling Shared Decision Making to Reduce Harm from Drug Interactions: An End-to-End Demonstration
Document Type:
Report
Research Method:
Mixed Methods, Questionnaire, Structured/Semi-Structured Interview, Usability Assessment
Technology:
Clinical Decision Support System, Dashboard, SMART/FHIR
Citation:
Thiess H, Del Fiol G, Malone DC, Cornia R, Sibilla M, Rhodes B, Boyce RD, Kawamoto K, Reese T. Coordinated use of Health Level 7 standards to support clinical decision support: Case study with shared decision making and drug-drug interactions. Int J Med Inform. 2022 Mar 21;162:104749. doi: 10.1016/j.ijmedinf.2022.104749. Epub ahead of print. PMID: 35358893.
Principal Investigator:
Malone, Daniel C.
Project Name:
Enabling Shared Decision Making to Reduce Harm from Drug Interactions: An End-to-End Demonstration
Document Type:
Journal Publication
Technology:
Clinical Decision Support System, SMART/FHIR
Citation:
Reese TJ, Del Fiol G, Morgan K, Hurwitz JT, Kawamoto K, Gomez-Lumbreras A, Brown ML, Thiess H, Vazquez SR, Nelson SD, Boyce R, Malone D. A shared decision-making tool for drug interactions between warfarin and nonsteroidal anti-inflammatory drugs: Design and usability study. JMIR Hum Factors. 2021 Oct 26;8(4):e28618. doi: 10.2196/28618. PMID: 34698649; PMCID: PMC8579222.
Principal Investigator:
Malone, Daniel C.
Project Name:
Enabling Shared Decision Making to Reduce Harm from Drug Interactions: An End-to-End Demonstration
Document Type:
Journal Publication
Research Method:
Interview, Mixed Methods, Usability Assessment
Technology:
Clinical Decision Support System, SMART/FHIR
Population:
Patient, Pharmacist, Physician
Disclaimer
Disclaimer details