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AHRQ tool designed to improve CAP clinical care
Decision-support tool is evidence-based
The Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, has unveiled a clinical decision-support tool for personal digital assistants (PDAs) that is designed to help clinicians deliver evidence-based medicine at the point of care. AHRQ’s new Pneumonia Severity Index Calculator (available from the AHRQ web site at http://pda.ahrq.gov/) is an interactive application for Palm Pilots and other PDAs to help physicians decide whether to hospitalize patients with community-acquired pneumonia (CAP). This is the first of what AHRQ anticipates will be several such clinical decision support tools for PDAs.
Developed by MDpda Design Inc. of Miami, the Pneumonia Severity Index Calculator is based on a clinical algorithm produced in 1997 by the AHRQ-funded multidisciplinary research team called the Pneumonia Patient Outcomes Research Team, or Pneumonia PORT.
The Pneumonia PORT developed and tested the Pneumonia Severity Index clinical algorithm to aid clinicians in treatment decisions for patients with CAP. It has been validated in a broad, randomized control trial1, AHRQ notes.
CAP contracted outside of a hospital or nursing home environment affects approximately 4 million Americans and costs approximately $10 billion to treat each year, and nearly all of those costs — 92% — are spent on treating patients who are hospitalized for care, AHRQ says.
Thus, the targeting of CAP "makes sense," says Daniel Stryer, MD, director for the Center for Quality Improvement and Patient Safety (CQuIPS) at AHRQ. "It’s a high-priority condition in that it impacts a lot of people each year, costs lots of money, and the research is certainly there," he explains.
"The evidence is there that something like this can make a difference, so it’s just a matter of getting it done and getting the tool out," Stryer adds.
The tool represents the direction in which the agency is headed, he continues. "We want to put people in a position to improve quality and solve problems, and part of that is through tools; they help make the right thing to do the easiest thing to do."
There are a number of quality advantages of using a tool such as this, he emphasizes. "What you want to do is be able to use the evidence that’s out there," he asserts.
"It’s incredibly cumbersome and unwieldy to have to go to a journal article and try to figure out what to do. If you had, say, a 62-year-old female with certain clinical factors, it would be totally impossible to make a treatment decision directly from the literature," Stryer notes.
"The other option is do it from your brain, and while as a whole, we do a surprisingly good job of creating these mental algorithms for measuring risk, we’re nowhere near as good as something like this. It just helps us do our jobs a little bit better — and there sure is evidence out there that tells me I’d rather not be subject to some of the tricks that minds can play," he points out.
Stryer offers this hypothetical example: "Let’s say I saw a patient in the ER who came in with pneumonia but otherwise looked pretty good, and I said, Hey, this is a healthy person. They may be breathing a little hard, but they look pretty good.’ So, I sent them home, and the next day they were sick as a dog and had to be intubated. I know the next 20 patients I see I’ll handle differently than I would have if I didn’t see that patient. This tool helps to keep your assessments objective."
For example, he notes, based on the input from the physician, the tool will produce a classification from 1-5, and in addition to the score, it will have a mortality risk.
"This way, you can discuss the results with the patient, giving them the information they need to make a decision, and together you can make a decision about whether they should be hospitalized," Stryer concludes.
The AHRQ Pneumonia Severity Index Calculator is available in Palm OS, Pocket PC, and HTML formats. Additional AHRQ PDA applications are being considered, according to AHRQ, but the agency is waiting to evaluate the response to this initial tool. Meanwhile, it is reviewing research and trying to determine what might make sense to develop next.
1. Fine MJ, et al. The hospital discharge decision for patients with community acquired pneumonia. Arch Inter Med 1997; 157:47-56.
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