Developing the VA Geriatric Scholars Programs' Clinical Dashboards Using the PDSA Framework for Quality Improvement

Zachary Burningham; Regina Richter Lagha; Brittany Duford-Hutchinson; Carol Callaway-Lane; Brian C. Sauer; Ahmad S. Halwani; Jamie Bell; Tina Huynh; Joseph R. Douglas; B. Josea Kramer

doi:10.1055/s-0042-1757553

Applied Clinical Informatics, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Appl Clin Inform 2022; 13(04): 961-970
DOI: 10.1055/s-0042-1757553

State of the Art/Best Practice Paper

Developing the VA Geriatric Scholars Programs' Clinical Dashboards Using the PDSA Framework for Quality Improvement

Autoren

Zachary Burningham

¹Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States

²Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Centers of Innovation (COIN), Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
Regina Richter Lagha

³Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Greater Los Angeles Medical Center, Los Angeles, California, United States
Brittany Duford-Hutchinson

²Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Centers of Innovation (COIN), Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
Carol Callaway-Lane

⁴Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Health Care System, Murfreesboro, Tennessee, United States
Brian C. Sauer

¹Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States

²Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Centers of Innovation (COIN), Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
Ahmad S. Halwani

²Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Centers of Innovation (COIN), Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States

⁵Department of Hematology, University of Utah, Salt Lake City, Utah, United States
Jamie Bell

¹Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States

²Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Centers of Innovation (COIN), Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
Tina Huynh

¹Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States

²Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Centers of Innovation (COIN), Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, United States
Joseph R. Douglas

³Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Greater Los Angeles Medical Center, Los Angeles, California, United States
B. Josea Kramer

³Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Greater Los Angeles Medical Center, Los Angeles, California, United States

⁶Division of Geriatric Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, United States

Abstract

Background Involving clinician end users in the development process of clinical dashboards is important to ensure that user needs are adequately met prior to releasing the dashboard for use. The challenge with following this approach is that clinician end users can undergo periodic turnover, meaning, the clinicians that played a role in the initial development process may not be the same individuals that use the dashboard in future.

Objectives Here, we summarize our Plan, Do, Study, Act (PDSA)-guided clinical dashboard development process for the VA Geriatric Scholars Program (GSP) and the value of continuous, iterative development. We summarize dashboard adaptations that resulted from two PDSA cycles of improvement for the potentially inappropriate medication dashboard (PIMD), one of many Geriatric Scholars clinical dashboards. We also present the evaluative performance of the PIMD.

Methods Evaluation of the PIMD was performed using the system usability scale (SUS) and through review of user interaction logs. Routine end users that were Geriatric Scholars and had evidence of 5 or more dashboard views were invited to complete an electronic form that contained the 10-item SUS.

Results The proportion of Geriatric Scholars that utilized the PIMD increased for each iterative dashboard version that was produced as a byproduct from feedback (31.0% in 2017 to 60.2% in 2019). The overall usability of the PIMD among routine users was found to be above average (SUS score: 75.2 [95% CI 70.5–79.8]) in comparison to the recommended standard of acceptability (SUS score: 68)

Conclusion The solicitation of feedback during dashboard orientations led to iterative adaptations of the PIMD that broadened its intended use. The presented PDSA-guided process to clinical dashboard development for the VA GSP can serve as a valuable framework for development teams seeking to produce well-adopted and usable health information technology (IT) innovations.

Keywords

visualization - American Geriatrics Society - clinical dashboard - early-stage usability - dashboard - electronic health record - quality improvement

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