Assessing the use of a clinical decision support tool for pain management in primary care. Issue 3 (15th September 2022) - Apathy, Nate C
Abstract: Objective: Given time constraints, poorly organized information, and complex patients, primary care providers (PCPs) can benefit from clinical decision support (CDS) tools that aggregate and synthesize problem-specific patient information. First, this article describes the design and functionality of a CDS tool for chronic noncancer pain in primary care. Second, we report on the retrospective analysis of real-world usage of the tool in the context of a pragmatic trial. Materials and methods: The tool known as OneSheet was developed using user-centered principles and built in the Epic electronic health record (EHR) of 2 health systems. For each relevant patient, OneSheet presents pertinent information in a single EHR view to assist PCPs in completing guideline-recommended opioid risk mitigation tasks, review previous and current patient treatments, view patient-reported pain, physical function, and pain-related goals. Results: Overall, 69 PCPs accessed OneSheet 2411 times (since November 2020). PCP use of OneSheet varied significantly by provider and was highly skewed (site 1: median accesses per provider: 17 [interquartile range (IQR) 9–32]; site 2: median: 8 [IQR 5–16]). Seven "power users" accounted for 70% of the overall access instances across both sites. OneSheet has been accessed an average of 20 times weekly between the 2 sites. Discussion: Modest OneSheet use was observed relative to the number of eligible patients seen with chronic pain. Conclusions: Organizations implementing CDS tools are likely to see considerable provider-level variation in usage, suggesting that CDS tools may vary in their utility across PCPs, even for the same condition, because of differences in provider and care team workflows. Lay Summary: Primary care providers can benefit from clinical decision support (CDS) tools that aggregate and synthesize problem-specific patient information. We describe the design and functionality of a CDS tool for chronic noncancer pain in primary care-OneSheet. For each relevant patient, OneSheet presents pertinent information in a single electronic health record view to assist primary care providers in completing guideline-recommended opioid risk mitigation tasks, review previous and current patient treatments, view patient-reported pain, physical function, and pain-related goals. We also report on the retrospective analysis of real-world usage of the tool in the context of a pragmatic trial. Overall, 69 providers accessed OneSheet 2411 times (since November 2020). Seven "power users" accounted for 70% of the overall access instances across both sites. We observed modest OneSheet use relative to the number of eligible patients seen with chronic pain. Organizations implementing CDS tools are likely to see considerable provider-level variation in usage, suggesting that CDS tools may vary in their utility across providers, even for the same condition, because of differences in provider and care team workflows.