CPM CarePoints Content Development

Transcription

1 CPM CarePoints Content Development Date: 03/06/2014 Evidence-based guidelines that can be accessed by clinicians at the point of care are a vital tool for boosting quality and ensuring consistency across the care continuum. By integrating researched evidence recommendations and best practices into the electronic medical record, providers minimize variance, improve outcomes and reduce liability associated with missed diagnosis or treatment information. Many hospitals already have developed, or are in the process of building, clinical decision-support tools such as protocols and pathways. However, this is a time- and resource-intensive process, given the sheer volume of information that must be assessed, organized and presented in a systematic manner to support workflow. And while some software vendors offer starter sets of clinical data and tools designed to assist in the development work, the frequent lack of an overall framework for creating, vetting, introducing and maintaining the guidelines can greatly reduce their value and utility. CPM CarePoints is a vendor-neutral database that can be pre-configured into -- or retroactively installed on -- virtually all commercially available EHR platforms. With more than 270 separate interprofessional clinical practice guidelines, care planning, and documentation content, the database represents the most comprehensive, evidence-based system on the market today. Summary The Elsevier CPM content development methodology supports the development of interprofessional evidence-based clinical practice guidelines and documentation content for the electronic health record. The Elsevier CPM Consortium brings the feedback, advice and validation from literally thousands of interprofessional clinicians from multiple specialties. This ensures that the CPM content reflects not only the best scientific and clinical information but also conforms to realities faced by patients, clinicians and working healthcare organizations. Intentional design and integration into clinician workflow supports the application of evidence into practice. The guidelines are an integral part of an overall solution to support the professional processes of care, including screening, assessment, intervention, education and outcome evaluation, for an interprofessional care team. The elements of CPM CarePoints represent a unique documentation model that supports both practice and standards-based interoperability. CPM s tools are further complemented by tested strategies designed to support effective implementation and concurrent change management. Organizational development, communications theory, interpersonal dynamics, systems thinking, complexity science and healthcare best practices all have been synthesized into concise roadmaps that help clinicians and administrators successfully deploy and harness the power of evidence-based guidelines at the point of care. 1

2 A Two-Pronged Approach The development methodology behind CPM Guidelines has been refined over 30 years and today involves a rigorous series of steps involving interprofessional clinicians from multiple specialties. This process is complemented and amplified by CPM s relationship with a consortium of hundreds of North American hospitals and health systems. The consortium - a voluntary organization made up of existing CPM clients -- provides invaluable feedback, advice and validation regarding all evidence-based guidelines produced by CPM. CPM s development methodology, combined with the consortium s continuous feedback loop, ensures that the guidelines reflect not only the best scientific and clinical information but also conforms to realities faced by patients, clinicians and working healthcare organizations. This unique combination of a rigorous, scientifically-based development methodology, and broad-based consensual validation involving literally thousands of practitioners, ensures that CPM Guidelines are the most advanced, comprehensive and intensely scrutinized decision support tools in the world. What s more, the process is ongoing: existing guidelines are regularly updated based on emerging science and knowledge, and several new guidelines are developed each year. Identifying a Need Input about which evidence-based guidelines should be developed comes from internal domain experts, consortium clinicians, national initiatives and current evidence. Decisions are driven primarily by identification and prioritization of need. For example, in developing transplant guidelines, CPM focused initially on perioperative and postoperative care for renal transplants, since kidney transplants are among the most common major transplant operations. Over time, the authorship team has expanded their collection to include guidelines for liver and heart transplants. After a guideline objective is identified, interprofessional clinician authors with expertise in the relevant specialty are assigned to the project. At least one of the authors is Masters-prepared. Working collaboratively, the authors pool their collective knowledge to achieve consensus regarding the objective and priorities for the guideline. Scouring the Literature The next step entails a comprehensive review of available research, literature, findings and guidance related to the specific guideline topic. Over the years, CPM has developed a detailed set of protocols and processes for executing literature and research reviews. General topic searches are done, along with question-driven searches designed to identify the latest information about 2

3 potential problems or complications. Search parameters are limited to the most recent evidence to ensure timeliness of the information. However, searchers are not precluded from looking back further to recover landmark articles if the information is deemed essential to the guideline development. CPM s standardized search methodology focuses on a variety of high-quality databases to identify available research and recent evidence. All searches are cataloged and archived. The author team then assigns a level and quality rating to collected evidence and a grade for each evidence recommendation utilizing the following parameters: Evidence Hierarchy Level Assignment Level I Level II Level III Level IV Level V Level VI Meta-analysis or systematic review of multiple randomized clinical trials Experimental (includes randomized clinical trials) Quasi-experimental quantitative study Systematic review of multiple descriptive studies or qualitative metasynthesis Non-experimental descriptive or qualitative designs Expert opinion Quality Accepted (+ + +) Accepted (+ +) Accepted (+) High quality, low risk of bias Good quality, low risk of bias Good quality, risk of confounding or bias Grading A B C Based on a credible body of research evidence Based on non-research reports Based on consensus of expert opinion Creating a Draft and Soliciting Feedback Following the leveling and grading process, the author group drafts the clinical practice guideline. The draft is then posted and consortium member experts are invited to review the guideline and provide feedback through an easy-to-use interactive tool. CPM encourages interprofessional involvement in the feedback process to help ensure that the guideline supports the scopes of practice of the interprofessional clinicians who provide care to patients with that particular medical diagnosis, treatment, procedure, problem, or human response. That means a wide range of specialists -- nurses, dietitians, respiratory therapists, social workers, physical therapists, speech language pathologists and others -- typically provide input from the perspective of their area of expertise and scope of practice, and validate the content within the guideline. 3

4 After a specific period of time the feedback is closed, the authors then collect, collate and assess all suggestions and recommendations and make determinations about which information to include in the final guideline based on current evidence. The authors review all feedback and document responses conveying whether the recommendation has been incorporated, and why or why not. For example, a recommendation may not be included because it is not supported by the literature, or is contra-indicated in the literature. Rigorous Vetting and Validation All new guidelines undergo a peer-review process which originated as an Institutional Review Board-approved process called Consensual Validation of Clinical Practice Guidelines. Developed by CPM, Consensual Validation provides a final, detailed validation of the guideline content and ensures collective agreement among content authors and multiple, reviewing practitioners. The process requires that qualified clinicians from consortium organizations scrutinize the guideline line-by-line and score each element. The scores are then compiled. The guideline is considered to be content valid if an established content validity index is met. Any portion of a guideline that scores below a specific threshold is revisited and changes are made in accordance with recommendations from the authors and reviewers. Updating Existing Guidelines To ensure that existing guidelines remain current, CPM clinician experts regularly review emerging literature and various specialty organization recommendations. Guidelines are updated using the same methodology described, and integrated into the next twice-yearly release of content. Customization It is important to note that CPM Guidelines are not prescriptive and do not provide a rigid pathway for diagnosis and treatment. Rather, they represent an aggregation of the best information on the specific topic - the best research evidence integrated with clinician feedback and patient values. The evidencebased clinical practice guidelines form the basis of the Plan of Care in an intentional design that integrates evidence into clinician workflow while at the same time, supporting individualized patient needs. Evidence-based Guidelines - A Brief Case Study Abington Hospital, located in the Philadelphia suburb of Abington, has implemented all of the CPM Guidelines for clinicians at the point of care. Diane Humbrecht, nurse director clinical excellence and innovation, says the results have reduced care variance, improved interprofessional collaboration and increased accountability among caregivers. It s very reassuring to know that nurses and others have access to the data they need to make confident, informed decisions, Humbrecht says. We 4

5 had some guidelines before, but the difference in terms of the quality of the CPM information and its ease of use is like night and day. We feel like we ve fundamentally transformed the way we provide care. Beyond boosting quality, the CPM Guidelines -- along with the interprofessional practice framework and clinical documentation system that accompanies them -- have played a central role in helping Abington achieve coveted Magnet Status under the Magnet Recognition Program, an initiative designed to recognize quality of care, professionalism and best practices in nursing. Today, the CPM Framework, CPM Guidelines and clinical documentation system -- combined with the hospital s electronic medical record technology -- are utilized throughout the hospital s medical/surgical, behavioral health, pediatrics, neonatal intensive care, and critical care units. The applications also are being rolled out in the neonatal intensive care and psychiatry departments. With workstations strategically placed on each unit, the practical benefits of the guidelines and documentation have been immediate, Humbrecht says. Helping Novices and Experts It gives the novice nurse immediate information that he or she needs to care for the patient, she says. At the same time, it provides more experienced clinicians with a reference point for a disease that they perhaps haven t seen in a while, or one they ve never cared for before. Now, signs and symptoms of complications, nursing interventions and patient education -- everything they need to be doing for that patient -- is clearly articulated and just a mouse-click away. And because the guidelines are embedded in the charting system at the point of care, they re readily accessible not just to nurses but also physicians, rehab medicine, nutritionists, pastoral care, respiratory therapists, social workers and case managers. Oversight and Accountability For clinical managers, the system also provides safeguards and transparency that helps ensure the highest quality care. I have great confidence when regulatory bodies show up, because I can look into the system for each patient and know the guidelines are being used for an interprofessional, individualized plan of care and the care is being documented, Humbrecht says. It s really provides a whole new level of oversight and accountability. Looking Ahead Improved care quality and a reduction of care variance will continue to be primary objectives as healthcare reform moves forward. The American Reinvestment and Recovery Act -- which has allocated nearly $20 billion 5

6 to support the implementation of a national EHR infrastructure over the next five years-- specifically stipulates quality objectives as a condition of provider funding. Thus, by implementing evidence-based guidelines, provider organizations will be well-positioned to reap the benefits of federal EHR assistance. More importantly, they ll be establishing a solid foundation for ensuring consistent, effective and scientifically up-to-date care. Taken in its entirety, the CPM evidence-based content development and validation process represents a comprehensive, empirical, interdisciplinary approach that is unmatched in the industry. Exhaustive evidence searches, followed by systematic information grading and multi-stage, broad-based and redundant vetting and review, produce guidelines that are scientifically sound, up-to-date and widely applicable across multiple disciplines and healthcare settings. About Elsevier For more than a century, healthcare professionals have trusted Elsevier content to support decisions about patient care. With a rich heritage of medical and scientific publishing, Elsevier proudly serves the information needs of more than 20 million healthcare professionals. When clinicians need evidence-based knowledge and content, Elsevier is the trusted source they rely upon. From our publishing roots, Elsevier has evolved along with the healthcare industry we serve. We still maintain our foundation of evidence-based content and trusted medical knowledge while focusing today on creating innovative solutions that deliver our content directly into the Electronic Health Record and clinical workflows. Elsevier s evidence-based, interprofessional solutions include care planning and clinical documentation, order sets, patient education, reference, skills and e-learning to improve clinical decision-making and drive better outcomes, with professional practice transformation services that guide you through solution implementation, adoption and practice advancement. 6

7 Elsevier s Clinical Solutions Care Planning and Clinical Documentation By streamlining workflows, practice and culture, we can promote safety and improve patient outcomes. CPM CarePoints is the only EHR-based care planning solution on the market that seamlessly integrates interprofessional care plans, evidence-based clinical practice guidelines and automated clinical documentation to drive collaborative, patient-centered care. CarePoints reduces practice variability, standardizes and improves the quality of documentation and promotes interprofessional collaboration across the continuum of care. Professional Practice Transformation Services The best way to improve healthcare is to improve the healthcare environment. And that starts by building a culture of excellence around the people, tools and technology. The CPM Transformation Services team is comprised of clinicians with decades of experience across hundreds of organizations, with in-depth knowledge and experience with Joint Commission, Meaningful Use and Magnet designation. We will work with you to customize a plan to help your organization optimize adoption of evidence-based care planning tools, advance interprofessional practice and achieve sustainable success. Patient Education and Engagement Engaging patients through education by delivering it at the right time, with the right technology can transform healthcare. ExitCare s interactive videos and educational handouts and tools can help care teams build meaningful connections with their patients, fueling better questions and conversations helping to create a patient who is truly engaged in his or her care. We were the first patient education provider in the industry to receive Meaningful Use certification as an EHR module for selective core and menu set objectives. Drug Reference and Decision Support As the world s largest clinical health science publisher, Elsevier is positioned to provide unsurpassed drug information that empowers healthcare professionals with timely, accurate, clinically relevant drug data where and when it s needed most through Clinical Pharmacology. Designed as a workflow solution and combined with comprehensive clinical calculators, drug identification and IV compatibility tools, Clinical Pharmacology is designed to enable clinicians to improve point-of-care decisions for positive patient outcomes. Evidence-based Nursing Content Mosby s Nursing Consult leverages content from leading resources to help nurses quickly find answers to pressing clinical questions and bring evidence-based best practices to the point of care. Resources include clinically focused, evidence-based monographs; nursing and medical reference texts; leading nursing journals; practice guidelines; peerreviewed clinical updates, and the latest drug information and calculators. Skills and Procedures Mosby s Skills is a comprehensive online solution, bringing more than 1,200 evidence-based skills and procedures together with competency management functionality to meet the learning needs of your organization. Mosby s Skills is authored and peer-reviewed following a rigorous editorial process by experienced nurses currently practicing in their clinical specialties. Content is continuously reviewed and revised based on the latest evidence, with updates published monthly. 7

8 Research Solutions Mosby s Index is the most robust journal abstracts and indexing database available for nurses and other healthcare professionals. Mosby s Index offers a refined design and enhanced capabilities to provide an unparalleled research experience for both infrequent users and experienced researchers. Continuing Education Mosby s elearning offers accredited continuing education courses for nurses and other healthcare professionals, with lessons covering orientation, cross-training and staff development. Our elearning content is created by highly qualified nurse educators in collaboration with key nursing associations, such as the American Association of Critical-Care Nurses, the Emergency Nurses Association and the Association for Nursing Professional Development. Order Sets InOrder is an intuitive, cloud-based order set solution that enables physicians, clinicians and informaticists to author, review and manage order sets in a collaborative environment. It adapts to your healthcare organization through terminology services that allow you to import your existing order sets and author order sets based upon your hospital s terminology and order items. InOrder content is evidence-based and intended for rapid access to optimal orders at the point of care. The content covers the Elsevier order sets that combine orderable items with clinical decision support guidance, the evidence to support those order sets and the on-going updates that could have an impact on order sets. Faster, Smarter Clinical Answers In response to the demand for a clinical reference tool that is comprehensive, trusted and provides a fast speed to answer, Elsevier developed ClinicalKey, which provides faster online access to relevant clinical answers. Only ClinicalKey delivers all of Elsevier s medical and surgical content in one dynamic resource, including more than 1,000 top books, over 500 top journals, thousands of videos and millions of images. With exclusive Smart Content, ClinicalKey delivers the faster, smarter clinical answers that power clinical decision making. CPM CarePoints Content Development Date: 03/06/2014 Contact Us: Online: cpmrc.com Phone: cpmrc@elsevier.com 8