Clinical Data Evaluation Presentation

Presentation Title Your Name Program Name or Degree Name, Walden University COURSE XXX: Title of Course Instructor Name Month XX, 202X Slide Title • Go to the “Home” tab at the top and click the “New Slide” or “Layout” button to access different formatting for your slides. • Choose formatting that presents your information in the most logical way. • Use consistent, grammatically parallel format for bulleted lists (for example, on this slide, each element begins with an imperative verb). • You can also consult APA’s suggestions on formatting lists. • End bullet points consistently, either with or without a period. Slide Title • Keep font of text consistent. • Be sure headings are consistent in their spacing, placement, size, etc. • Consider using the slide after the title slide to summarize your presentation’s points (like an abstract for a paper). Slide Title Your slides can also contain entire paragraphs, like this one does. In both paragraphs and bulleted lists in your presentation, citation rules apply just as they do in papers: when using or referencing another author’s ideas, you must cite that source. When incorporating a citation in a slide, do so just as you would in a traditional paper: According to Jones (2020), presentations are not very different from papers. • According to Smith and Cat (2020), you should make your presentation great, not just good. Use APA style rules to format any tables and figures in your presentation: Figure 1 Title Reflecting Figure Information Note. Any needed general notes on figure. From “Utilizing Bar Graphs,” by A. Jones, 2020, Journal of Handy Graphs, 76(2), p. 3 (https://doi.org/10.123.45/ abc). Reprinted with permission. Slide Title • Remember to adhere to any assignment guidelines regarding presentation format. This template contains suggestions only. • Keep in mind that there is no such thing as an “APA standard PowerPoint.” Review our presentation tips for more information! • Visit the Academic Skills Center for more tips on how to use PowerPoint or visit Microsoft’s PowerPoint help and learning website. Slide Title

• Always include a reference list at the end of your presentation, just like you would in a paper. Reference list entries take the same format they would in a paper, including a hanging indent. Visit the Common Reference List Examples page for the correct APA format. Here are a few examples: Jones, P. (2020). This great book. Publisher. Smith, W., & Cat, D. (2020). How to make a good presentation great. Presentations Quarterly, 45(4), 56-59. https://doi.org/10.123.45/abc COMPARISON OF EMORY HEALTH UNIVERSITY HOSPITAL AND GRADY MEMORIAL HOSPITAL BY CATEGORIES ESTABLISHMENT The hospitals, in comparison, are both based in Atlanta, Georgia. Emory University Hospital (EUH) was established in 1904, 1.4 miles away from Atlanta, GA, and it was formerly known as the Wesley Memorial Hospital. Today, it is said that 733 beds are available in this facility that mainly gives healthcare to acutely ill patients. As this is a University Hospital, the Medicine faculty of the said university are mainly the staff. Since their establishment, they had specialized in cardiology, oncology, transplantation, cardiac surgery, neurosciences, and ophthalmology. On the other hand, Grady Memorial Hospital (GMH) was established a few years older than the former hospital in 1892. This is at least 0.5 miles away from Atlanta, GA, and both hospitals specialize in giving acute care. This is a public hospital that is known as one of the best trauma centers at Level I. The influential politician named Henry W. Grady advocated for a public city hospital; therefore, this was named after him. It is a larger facility as of today that contains 961 beds. Medicare.gov had assessed the comparison of these hospitals in different sectors. OVERALL RATING In terms of the overall rating, EUH has an overall rating of 3 stars, while GMH of only 1 star. Based on Mortality, EUH shows a better performance above the national average. This means that whether the hospitals are successful in admitting patients, which are then assessed in their effectiveness of administering treatment, providing safety, providing emergency medicine, and the timeliness of their care, which all measures this particular category.

They do not differ in terms of the timeliness of care, the safety of care, and efficiency in using medical imaging, but EUH performs better in some sectors. Readmission of patients or people who want to get treated again based on health records possibly points to this. The patient experience and effectiveness of care reflect the national average, meaning that the quality of care they received is neither greater nor lesser than the suggested national average. PATIENT SURVEY RATING In this category, Medicare both gave the hospitals 2 stars each, but within the breakdown of the patient survey rating by category, EUH outstands GMH mostly within 3%-9%. As communication is vital in every aspect, it seems that the patients appreciate it much more if they are briefed before administering healthcare and treatment if nurses are doctors are always available to talk or within reach, cleanliness of their rooms are observed, the treatment is well understood, as well as the instructions they should do in case treatment should be continued at home. TIMELY & EFFECTIVE CARE This category assesses how quickly these hospitals provide care that patients need, especially in emergencies. GMH shows some promising advantages in certain aspects of giving timely & effective care. For sepsis and colonoscopy care, GMH leads in terms of having patients who received the proper and appropriate recommendation and follow-up treatments. Both hospitals are said to receive the same amount of patient volume annually in the emergency department. Still, GMH showed higher percentages of patients who were not seen by the doctors who left the department, showing a high waiting time. This is supported by the average times spent by patients in the emergency department, wherein EUH again had the advantage since fewer minutes were recorded against the latter. The data for other aspects such as pregnancy and delivery care, CT scans, and cardiac imaging show a mixed result on which is better, which reflects the rating that these hospitals got. COMPLICATIONS & DEATHS Patients come to the hospital, hoping to receive the best practices possible for treatment. In this category, this is where the rates for other complications or conditions may arise as the medical practitioners administer treatment, and in worse cases, the patient may die. Generally, EUH shows better and promising data than GMH, wherein it surpasses the national benchmark most of the time. This means that in a certain aspect like Central line-associated bloodstream infections (CLABSI) in ICUs, EUH performs better. There are fewer complications than patients encounter whenever they admit themselves to the hospital for treatment. One alarming data stated by Medicare is the benchmark for Surgical Site Infections (SSI). This meant that GMH should improve on following the standard health practices in conducting this kind of medical operation on patients. This could also infer that patients are re-administering themselves for getting treated once again. The death rates are not that different from the national rate, meaning it is neither remarkable nor below satisfactory. UNPLANNED HOSPITAL VISITS This category is concerned with readmission of returning patients, which means a reduction in healthcare quality that the hospital had previously given, since the patient is back, risking themselves for healthcareassociated infections, and is not really budget-friendly. Based on the data, GMH shows a worse readmission rate by 18%, exceeding the 15.6% national result of 2.4%. Moreover, the hospital returns and readmission rates for EUH are lower, and sometimes a little lower than the national rate, which is neutral. Room for improvement is needed for patients receiving outpatient chemotherapy as the rates of admissions are higher than the national rate (12.5%), which is at 15.5%. Other than that, the ratio of unplanned visits after hospital outpatient surgery. This does not show more details in the data, but both show an advantage and disadvantage.

This means more patients are coming in on unexpected occasions. Still, when quality is in the line, this may mean that the previous outpatient surgery is not satisfactory and needs follow-up. PSYCHIATRIC UNIT SERVICES This category assesses whether the patients with underlying mental health conditions receive quality health care in these hospitals. As indicated on the available data, it is either EUH does not have inpatient psychiatric units available or does not have the psychiatric data to report during the assessment report. GMH shows promising performance in preventive care & screening because it exceeds the national and GA average. They generally need improvement in providing and administering substance use treatment because they may be successful in giving brief interventions for patients with alcohol addiction, but long-term treatment but screenings, counseling, giving prescriptions, and follow-up care should be improved. Unplanned visits show a percentage close to the national rate. It can be understood based on this data why GMH is one of the best hospitals/trauma centers for assisting patients with traumatic conditions. PAYMENT & VALUE OF CARE Based on the data, beneficiaries generally use their Medicare to assist them in their hospital expenses. Most of the payments based on the ailments that need treatment are generally lower at EUH than the national average payment. Payment for heart failure patients is greatly lower at GMH, which is lower with almost $2,000 reduced. Generally, the data provided does not greatly exceed the national averages, and if they did, it is only at small values. The ones that are alarming though is that the payment for the treatments may generally be low at EUH, but the death rate percentages there are higher compared to the data for GMH, which means that there is always an improvement that can be done in terms of the health care that should be given to these patients. It may be understood that GMH is a public hospital. Still, it could be recommended that the payments should be reduced since some payments, such as for pneumonia patients, exceed the national average payment. However, the payment could be understood because this is for the usage of the facilities and payments for the medical practitioners. RECOMMENDATIONS: The following are the recommendations on why clinical decision systems can highly be beneficial in healthcare organizations and possibly also help increase the quality of healthcare of the hospitals in comparison: • Organize health records and data of what was used upon administering treatments for all patients. Clinical decision systems, together with Electronic Health Records (EHR), would be powerful in having an organized database on all patients that were admitted to a specific hospital, which also contains the history of their diseases, information regarding the medical practitioners who gave the treatment, as well as in improving the quality of health care that will be given to future patients (Sutton, et al., 2020). • Use Clinical Decision Systems to decrease patients’ waiting time that admitted themselves for a check-up with the doctors but left either due to various reasons, such as the long waiting time, unaffordable treatment, or poor quality of treatment previously received. The example of long waiting times for patients at Grady Memorial Hospital was recorded through the data provided above, recommended for improvement. As a nurse leader, this will also help monitor what could be improved within the facility, such as the lack of medical practitioners, the supply of frequently needed medical supplies for a specific ailment, and support in creating diagnoses for patients’ illness.

• Costs for medical treatments should be monitored through clinical decision systems (Yaraghi et al., 2018). When a hospital is equipped with a quality CDS, not only would there be better documentation provided for a patient, especially when another doctor would handle them, but also reduce or suggest what parts of certain treatment processes can be minimized, considering several factors like the infrequent occurrence of the disease on patients, and the amount of workload to be done to administer treatment. • Reduce prescription/medication errors. Having a clinical decision support system available for a medical facility helps reduce the treatment errors that were given to a patient since a history or record of the ailment previously conducted on another patient could help the current patient and future patients to receive treatment of mediocre quality, and even help the doctors improve the quality of healthcare that they could give. This provides a chain effect of reducing waiting time, lesser readmissions, and more patients to accommodate in times that there are peak numbers of patients during the certain flu or season where a certain ailment gets frequent in many people and prioritize critical alerts which are inevitable. As a nurse leader, this will help them monitor their co-nurses to handle incoming patients more effectively easily and lesser delays since the times for coming up with a decision for the treatment and availability for hospital beds and other supplies can be given more smoothly with a system like CDSS available. • Based on research related to using an app for discharging from hospitals to nursing homes (Mukamel et al., 2016), using a CDSS, preferably an app that enables patients to help decide which nursing home to be transferred to, gives satisfactory feedbacks, relaxed and sound decisions on what treatment they should get, and also allows them with a choice whether or not to be assisted with a medical practitioner upon making a decision. This helps with the communication of a patient to their nurses or doctors and assure themselves that they would receive quality health care and reduce their length of stay. REFERENCES Mukamel, D., Amin, A., Weimer, D., Ladd, H., Sharit, J., Schwarzkopf, R., & Sorkin, D. (2016). Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes. Health Services Research, 51(6), 2076–2094. https://doi.org/10.1111/1475-6773.12588 Sutton, R., Pincock, D., Baumgart, D., Sadowski, D., Fedorak, R., & Kroeker, K. (2020). An overview of clinical decision support systems: benefits, risks, and strategies for success. npj Digital Medicine, 3(1), 1–10. https://doi.org/10.1038/s41746-020-0221-y Yaraghi, N., Wang, W., Gao, G., & Agarwal, R. (2018). How Online Quality Ratings Influence Patients’ Choice of Medical Providers: Controlled Experimental Survey Study. Journal of Medical Internet Research, 20(3), 1–32. https://doi.org/10.2196/jmir.8986 www.nature.com/npjdigitalmed REVIEW ARTICLE OPEN An overview of clinical decision support systems: benefits, risks, and strategies for success Reed T. Sutton 1 , David Pincock2, Daniel C. Baumgart1, Daniel C. Sadowski1, Richard N. Fedorak1 and Karen I. Kroeker1* Computerized clinical decision support systems, or CDSS, represent a paradigm shift in healthcare today. CDSS are used to augment clinicians in their complex decision-making processes. Since their first use in the 1980s, CDSS have seen a rapid evolution. They are now commonly administered through electronic medical records and other computerized clinical workflows, which has been facilitated by increasing global adoption of electronic medical records with advanced capabilities.

Despite these advances, there remain unknowns regarding the effect CDSS have on the providers who use them, patient outcomes, and costs. There have been numerous published examples in the past decade(s) of CDSS success stories, but notable setbacks have also shown us that CDSS are not without risks. In this paper, we provide a state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms. We conclude with evidence-based recommendations for minimizing risk in CDSS design, implementation, evaluation, and maintenance. 1234567890():,; npj Digital Medicine (2020)3:17 ; https://doi.org/10.1038/s41746-020-0221-y INTRODUCTION: WHAT IS A CLINICAL DECISION SUPPORT SYSTEM? A clinical decision support system (CDSS) is intended to improve healthcare delivery by enhancing medical decisions with targeted clinical knowledge, patient information, and other health information.1 A traditional CDSS is comprised of software designed to be a direct aid to clinical-decision making, in which the characteristics of an individual patient are matched to a computerized clinical knowledge base and patient-specific assessments or recommendations are then presented to the clinician for a decision.2 CDSSs today are primarily used at the point-of-care, for the clinician to combine their knowledge with information or suggestions provided by the CDSS. Increasingly however, there are CDSS being developed with the capability to leverage data and observations otherwise unobtainable or uninterpretable by humans. Clinical Data Evaluation Presentation

Computer-based CDSSs can be traced to the 1970s. At the time, they had poor system integration, were time intensive and often limited to academic pursuits.3,4 There were also ethical and legal issues raised around the use of computers in medicine, physician autonomy, and who would be at fault when using the recommendation of a system with imperfect ‘explainability’.5 Presently, CDSS often make use of web-applications or integration with electronic health records (EHR) and computerized provider order entry (CPOE) systems. They can be administered through desktop, tablet, smartphone, but also other devices such as biometric monitoring and wearable health technology. These devices may or may not produce outputs directly on the device or be linked into EHR databases.6 CDSSs have been classified and subdivided into various categories and types, including intervention timing, and whether they have active or passive delivery.7,8 CDSS are frequently classified as knowledge-based or non-knowledge based. In knowledge-based systems, rules (IF-THEN statements) are created, with the system retrieving data to evaluate the rule, and producing an action or output7; Rules can be made using literature-based, practice-based, or patient-directed evidence.2 CDSS that are non-knowledge based still require a data source, but the decision leverages artificial intelligence (AI), machine learning (ML), or statistical pattern recognition, rather than being programmed to follow expert medical knowledge.7 Clinical Data Evaluation Presentation

Nonknowledge based CDSS, although a rapidly growing use case for AI in medicine, are rife with challenges including problems understanding the logic that AI uses to produce recommendations (black boxes), and problems with data availability.9 They have yet to reach widespread implementation. Both types of CDSS have common components with subtle differences, illustrated in Fig. 1. CDSS have been endorsed by the US Government’s Health and Medicare acts, financially incentivizing CDS implementation into EHRs.10 In 2013, an estimated 41% of U.S. hospitals with an EHR, also had a CDSS, and in 2017, 40.2% of US hospitals had advanced CDS capability (HIMSS Stage 6).11 Elsewhere, adoption rates of EMRs have been promising, with approximately 62% of practitioners in Canada in 2013.12 Canada has had significant endorsement from the government level, as well as Infoway, a not-for-profit corporation.13 England has also been a world leader in healthcare IT investment, with up to 20 billion euros …Clinical Data Evaluation Presentation