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CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(03): 594-599
DOI: 10.1055/s-0043-1769913
Research Article

Uptake of a Cervical Cancer Clinical Decision Support Tool: A Mixed-Methods Study

Nathalie Huguet
1   Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
,
David Ezekiel-Herrera
1   Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
,
Rose Gunn
2   OCHIN Inc., Portland, Oregon, United States
,
Alison Pierce
2   OCHIN Inc., Portland, Oregon, United States
,
Jean O'Malley
2   OCHIN Inc., Portland, Oregon, United States
,
Matthew Jones
2   OCHIN Inc., Portland, Oregon, United States
,
Miguel Marino
1   Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States
,
Rachel Gold
2   OCHIN Inc., Portland, Oregon, United States
3   Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, United States
› Author Affiliations Funding/Support This work was supported by the National Cancer Institute of the National Institutes of Health (grant number P50CA244289). This P50 program was launched by NCI as part of the Cancer Moonshot. The funding source had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Abstract

Objectives Clinical decision support (CDS) tools that provide point-of-care reminders of patients' care needs may improve rates of guideline-concordant cervical cancer screening. However, uptake of such electronic health record (EHR)-based tools in primary care practices is often low. This study describes the frequency of factors associated with, and barriers and facilitators to adoption of a cervical cancer screening CDS tool (CC-tool) implemented in a network of community health centers.

Methods This mixed-methods sequential explanatory study reports on CC-tool use among 480 community-based clinics, located across 18 states. Adoption of the CC-tool was measured as any instance of tool use (i.e., entry of cervical cancer screening results or follow-up plan) and as monthly tool use rates from November 1, 2018 (tool release date) to December 31, 2020. Adjusted odds and rates of tool use were evaluated using logistic and negative-binomial regression. Feedback from nine clinic staff representing six clinics during user-centered design sessions and semi-structured interviews with eight clinic staff from two additional clinics were conducted to assess barriers and facilitators to tool adoption.

Results The CC-tool was used ≥1 time in 41% of study clinics during the analysis period. Clinics that ever used the tool and those with greater monthly tool use had, on average, more encounters, more patients from households at >138% federal poverty level, fewer pediatric encounters, higher up-to-date cervical cancer screening rates, and higher rates of abnormal cervical cancer screening results. Qualitative data indicated barriers to tool adoption, including lack of knowledge of the tool's existence, understanding of its functionalities, and training on its use.

Conclusion Without effective systems for informing users about new EHR functions, new or updated EHR tools are unlikely to be widely adopted, reducing their potential to improve health care quality and outcomes.

Keywords

clinical decision support - community health centers - cervical cancer screening - mixed methods

Protection of Human and Animal Subjects

The Institutional Review Board reviewed and approved this study.


Supplementary Material



Publication History

Received: 22 January 2023

Accepted: 26 April 2023

Article published online:
02 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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