Environmental Scan

Translating knowledge gained from Patient-Centered Outcomes Research (PCOR) into clinical practice is key to healthcare quality improvement. A promising way to ensure that PCOR informs clinical care is through clinical decision support (CDS) interventions, which are technical and non-technical approaches that make it easier for care teams – including patients – to make decisions and take actions known to enhance outcomes. Yet best practices are only beginning to emerge and numerous barriers exist: poor coordination among stakeholders, lack of interoperability, sub-optimal implementations, and poor usability to state but a few. Experts agree that more rapidly incorporating PCOR findings into clinical workflow via CDS will require a coordinated effort among multiple stakeholders who jointly promote best practices, collaborate on innovative means for knowledge dissemination and updates, and develop groundbreaking applications that ultimately improve healthcare quality.

The Agency for Healthcare Research and Quality awarded RTI International a U18 cooperative agreement to develop The Patient-Centered Outcomes Research Clinical Decision Support Learning Network (PCCDS-LN) to bring together stakeholders to promote a sustainable community around developing, disseminating, and applying PCOR-enabled CDS. The PCCDS-LN is designed to accelerate collaborative learning, overcome barriers and reinforce facilitators for effective CDS use, and evaluate the impact of its efforts. As part of the effort to accelerate learning and address the barriers and facilitators to PCOR-based CDS, the research team was to produce an environmental scan that lends insight into the current state of PCOR-based CDS and offer strategic vision for the PCCDS-LN in years ahead. This environmental scan is a result of numerous discussions with members of the PCCDS-LN Senior Research Team, experts from across multiple sectors, and literature searches. The findings are meant to provide a “springboard for action” to help the PCCDS-LN carry out its vision: to create an ecosystem that allows all stakeholders reduce the friction of turning knowledge from PCOR findings into CDS-enabled actions that produce better care and outcomes.

A critical artifact from this environmental scan is the Analytic Framework for Action (AFA), which graphically displays and defines areas of focus around the prioritization, implementation, and evaluation of PCOR-based CDS (see Exhibit 1-1). The AFA, which was developed and vetted by many of the experts we engaged over the course of this effort, provides the means by which we organized the findings and recommendations.

Exhibit 1‑1.  The PCCDS-LN Analytic Framework for Action

AFA -- graphical representation

We generated key takeaways from each of the AFA’s categories:

  • Addressing External Factors: Providing a working definition “PCOR-based CDS” so to promote effective discussions that lead to action:
    • “PCOR-based CDS helps patients and their care teams apply evidence from patient-centered outcomes research to enhance care processes and their results. Approaches include promoting shared decision-making, incorporating patient reported outcomes, factoring in patient preferences to generate patient-specific recommendations for care and others.”
  • Prioritizing PCOR Findings for Dissemination via CDS: Involving multiple stakeholders in use cases to develop a mechanism for prioritizing PCOR for CDS.
  • Authoring CDS Interventions: Engaging stakeholders to promote standards and access to data that promote effective PCOR-based CDS.
  • Implementing CDS Interventions: Promoting research and knowledge-sharing around ways PCOR-based CDS can be, and is being, operationalized for people and their caregivers.
  • Measuring Decisions and Outcomes: Disseminating the various ways that PCOR-based CDS measurably impacts health and healthcare outcomes.
  • Learning from PCOR-based CDS Experience: Partnering with relevant organizations such as the Patient-Centered Outcomes Research Institute (PCORI) and to feed learning from the implementation and use of PCOR-based CDS back into the research and deployment cycle.

This environmental scan identifies numerous barriers and highlights multiple actionable opportunities for the PCCDS-LN. Stakeholders are demonstrably engaged through the PCCDS-LN’s governance structures including its Steering Committee and Advisory Council. Additional activity is now underway in the form of a Barriers and Facilitators Work Group, which is engaged in case development to expand upon the findings in this environmental scan. The environmental scan findings will also be reformatted and shared with several stakeholder groups as appropriate: articles, webinars, and conference presentations. Tailoring the results will make more visible the challenges and recommendations to authoring, developing, implementing, and evaluating PCOR-based CDS.

We would like to thank the many people who offered their time, insights, and expertise to the development of this environmental scan. Their contributions are what made this report possible.

A link to the full report is included below.