Summary
Background: Clinician compliance with clinical guidelines in the treatment of patients with Hepatitis
C (HCV) has been reported to be as low as 18.5%. Treatment is complex and patient
compliance is often inconsistent thus, active clinician surveillance and support is
essential to successful outcomes. A clinical decision support system (CDSS) embedded
within an electronic health record can provide reminders, summarize key data, and
facilitate coordination of care. To date, the literature is bereft of information
describing the implementation and evaluation of a CDSS to support HCV treatment.
Objective: The purpose of this case report is to describe the design, implementation, and initial
evaluation of an HCV-specific CDSS while piloting data collection metrics and methods
to be used in a larger study across multiple practices.
Methods: The case report describes the design and implementation processes with preliminary
reporting on impact of the CDSS on quality indicator completion by comparing the pre-CDSS
group to the post-CDSS group.
Results: The CDSS was successfully designed and implemented using an iterative, collaborative
process. Pilot testing of the clinical outcomes of the CDSS revealed high rates of
quality indicator completion in both the pre- and post-CDSS; although the post-CDSS
group received a higher frequency of reminders (4.25 per patient) than the pre-CDSS
group (.25 per patient).
Conclusions: This case report documents the processes used to successfully design and implement
an HCV CDSS. While the small sample size precludes generalizability of findings, results
did positively demonstrate the feasibility of comparing quality indicator completion
rates pre-CDSS and post-CDSS. It is recommended that future studies include a larger
sample size across multiple providers with expanded outcomes measures related to patient
outcomes, staff satisfaction with the CDSS, and time studies to evaluate efficiency
and cost effectiveness of the CDSS.
Keywords
Decision support system - Hepatitis C - healthcare quality indicators - chronic core
model - nurse practitioner advanced practice nursing - access and evaluation health
care quality
