Clostridium difficile infections (CDI) are a significant burden to patients and healthcare systems. In 2018, the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program issued a call for pilot strategies to disseminate EPC systematic reviews into clinical practice. Clinical pathways are one method for translating evidence into practice. In this pilot study, we used our pathway development and dissemination methodology to translate findings from the 2016 AHRQ EPC CDI report into a treatment pathway. We employed two technology-based interventions for dissemination.
Methods: The pathway was disseminated within existing provider EHR workflow and through a cloud-based dissemination platform, accessible to all health system clinicians and staff. Outcomes: (1) feasibility of pathway development from the EPC report, (2) usability of the EHR integrated pathway, and (3) provider adoption. Outcome evaluation: (1) qualitative methods, time measurements; (2) usability testing with a small group of clinicians; (3) total provider pathway clicks (pathways platform and the EHR).
Results: Outcome 1: AHRQ dissemination pilot hours 331: 272 hours for AHRQ report guideline and pathway synthesis; 37 hours for pathway development. Outcome 2: one ordering provider initially saw the reference link in the order entry screen while placing medication orders during the first usability test. Once alerted to the reference link, all successfully used the pathway for appropriate medication ordering, without prompting or assistance and in less than ten seconds. Outcome 3: 403 cloud-based platform clicks (04/16/2018-10/17/2018); 12 EHR clicks (9/17/2018-10/17/2018).
Conclusions: AHRQ reports should include syntheses of guidelines to be useful for pathway development. This method of EHR pathway integration can provide timely ordering guidance to clinicians when they are aware of this resource.

Describe the new knowledge and additional skills the participant will gain after attending your presentation.: Participants will be able to describe approaches to developing evidence-based, multi-disciplinary clinical pathways and disseminating the pathway as a clinical decision support intervention in the electronic health record (EHR).


Emilia Flores (Presenter)
University of Pennsylvania Health System

J. Jane Jue, ECRI Institute
Gina Giradi, ECRI Institute
Karen Schoelles, ECRI Institute
Susan Regli, University of Pennsylvania Health System
Mark Thai, University of Pennsylvania Health System
Ashley Donlon, University of Pennsylvania Health System
Jeffrey Landgraf, University of Pennsylvania Health System
Colleen Mallozzi, University of Pennsylvania Health System
Christine VanZandbergen, University of Pennsylvania Health System
PJ Brennan, University of Pennsylvania Health System
Craig Umscheid, University of Pennsylvania Health System

Presentation Materials: