IMplementing Predictive Analytics towards efficient COPD Treatments (IMPACT): protocol for a stepped-wedge cluster randomized impact study
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Published:2023-02-14
Issue:1
Volume:7
Page:
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ISSN:2397-7523
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Container-title:Diagnostic and Prognostic Research
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language:en
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Short-container-title:Diagn Progn Res
Author:
Michaux Kristina D., Metcalfe Rebecca K., Burns Paloma, Conklin Annalijn I., Hoens Alison M., Smith Daniel, Struik Laura, Safari Abdollah, Sin Don D., Sadatsafavi MohsenORCID, Bansback Nick, Barn Prabjit, Bottorff Joan L., Bryan Stirling, Carlsten Chris, De Vera Mary, Gershon Andrea, Gupta Samir, Gustafson Paul, Mokhtaran Mehrshad, Johnson Jim, Joshi Phalgun, Leung Janice, Lynd Larry D., Simmers Brian, Sutherland Janet, Vinay Dhingra,
Abstract
Abstract
Introduction
Personalized disease management informed by quantitative risk prediction has the potential to improve patient care and outcomes. The integration of risk prediction into clinical workflow should be informed by the experiences and preferences of stakeholders, and the impact of such integration should be evaluated in prospective comparative studies.
The objectives of the IMplementing Predictive Analytics towards efficient chronic obstructive pulmonary disease (COPD) treatments (IMPACT) study are to integrate an exacerbation risk prediction tool into routine care and to determine its impact on prescription appropriateness (primary outcome), medication adherence, quality of life, exacerbation rates, and sex and gender disparities in COPD care (secondary outcomes).
Methods
IMPACT will be conducted in two phases. Phase 1 will include the systematic and user-centered development of two decision support tools: (1) a decision tool for pulmonologists called the ACCEPT decision intervention (ADI), which combines risk prediction from the previously developed Acute COPD Exacerbation Prediction Tool with treatment algorithms recommended by the Canadian Thoracic Society’s COPD pharmacotherapy guidelines, and (2) an information pamphlet for COPD patients (patient tool), tailored to their prescribed medication, clinical needs, and lung function. In phase 2, we will conduct a stepped-wedge cluster randomized controlled trial in two outpatient respiratory clinics to evaluate the impact of the decision support tools on quality of care and patient outcomes. Clusters will be practicing pulmonologists (n ≥ 24), who will progressively switch to the intervention over 18 months. At the end of the study, a qualitative process evaluation will be carried out to determine the barriers and enablers of uptake of the tools.
Discussion
The IMPACT study coincides with a planned harmonization of electronic health record systems across tertiary care centers in British Columbia, Canada. The harmonization of these systems combined with IMPACT’s implementation-oriented design and partnership with stakeholders will facilitate integration of the tools into routine care, if the results of the proposed study reveal positive association with improvement in the process and outcomes of clinical care. The process evaluation at the end of the trial will inform subsequent design iterations before largescale implementation.
Trial registration
NCT05309356.
Funder
Canadian Institutes of Health Research
Publisher
Springer Science and Business Media LLC
Subject
Applied Mathematics,General Mathematics
Reference59 articles.
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