Lance's Corner

AHRQ Issues CDSiC Newsletter

Aug 21, 2024

The Agency for Healthcare Research and Quality (AHRQ) has issued its Clinical Decision Support Innovation Collaborative (CDSiC) newsletter.

Issue Number 21 | August 21, 2024
In this edition of the Insider, we highlight three new AHRQ CDSiC-developed resources focused on cutting-edge patient-centered clinical decision support (PC CDS) topics, including leveraging artificial intelligence (AI), analyzing override reasons, and prioritizing areas for measurement, as well as a PC CDS-focused funding opportunity from AHRQ.
Table of Contents:
While AI has been used with CDS to improve healthcare delivery, there has not yet been an exploration of opportunities, considerations, and recommendations for the use of AI to scale PC CDS and overcome implementation barriers. To fill this gap, the AHRQ CDSiC Implementation, Adoption, and Scaling Workgroup developed a report that provides an overview of current approaches for using AI to scale PC CDS, outlines existing challenges, and documents opportunities to advance this important area.

The report identifies five dimensions of PC CDS to which AI can be applied to facilitate scaling: 1) automate processes, 2) facilitate technical development and support of PC CDS, 3) complement direct/immediate clinician interaction, 4) support cognitive processes and decision making, and 5) facilitate sharing and replication of PC CDS. The findings in this report will enable PC CDS stakeholders to better understand and leverage AI to scale PC CDS more widely and encourage the use of AI in PC CDS among clinicians, patients, and their care teams. Read the report here!
Recipients of PC CDS alerts and recommendations may choose not to follow the guidance for various reasons. Some CDS systems require recipients to identify a reason when they choose not to follow the guidance, called an "override reason," which can provide insight into ways CDS can be improved. Recognizing the value of this information to CDS researchers and developers, the AHRQ CDSiC Standards and Regulatory Frameworks Workgroup created an initial taxonomy of override reasons composed of reasons that may be selected by patients, caregivers, clinicians, or other recipients of PC CDS.

The taxonomy serves as a foundation for analysis, providing a shared set of domains and subdomains that capture a broad range of potential override reasons. It supports PC CDS developers and researchers when analyzing why users do not accept PC CDS guidance, and is especially useful for facilitating comparison of overrides of PC CDS across different institutions to share lessons learned.
Outcome measurement is key to determining if PC CDS is achieving its goals. Since PC CDS is intended to support patients' decision making, measurement should assess if CDS influences outcomes that are important to patients. To support this goal, the AHRQ CDSiC Measurement and Outcomes Workgroup elicited feedback from patients and patient advocates on which patient health journey measures should be prioritized when assessing PC CDS. These important findings, and critical areas for future work, are available in a new AHRQ CDSiC report.

PC CDS researchers and implementers, as well as healthcare organizations, can use this report to inform which patient-centered measurement areas should be included in PC CDS assessments.




Read the report by clicking below!



 
Implementing and Evaluating PC CDS Strategies in Real-World Settings (U18) 

AHRQ recently published a Notice of Funding Opportunity (NOFO) titled Implementing and Evaluating PC CDS Strategies in Real-World Settings RFA-HS-24-003 (U18). Applicants will propose innovative collaborative research to understand how CDS tools in real-world healthcare settings can be improved to become more patient-centered. Funded research will contribute to generalizable knowledge about how patients, families, and caregivers can become meaningful partners in the codesign, implementation, use, and evaluation of PC CDS.

Since 2016, AHRQ's Patient-Centered Outcomes Research (PCOR) CDS Initiative, and the CDSiC in particular, have developed resources that are now publicly available for investigator-initiated research to further develop, test, and build upon in real-world healthcare settings. Using these resources as starting materials, applicants will propose innovative collaborative research to understand how CDS tools in real-world healthcare settings can be improved to become more patient-centered. Read more about this exciting opportunity on AHRQ's funding page here. 

Applications for this opportunity are due on September 12, 2024.
The 2024 MCBK Global Meeting will take place virtually on October 23, 2024. The meeting will focus on exploring generative AI, including the role generative AI can play in improving human health by mobilizing computable knowledge around the world.
 
Find out more – and register for free – at the MCBK website.
All 20 past issues of the Insider are now available on our website! Click here to view our past issues, which share more about the AHRQ CDSiC products that have been produced so far and important resources for PC CDS stakeholders.
This section highlights two recently published journal articles that feature topics of interest to CDSiC stakeholders. These articles further the PC CDS research agenda with their cutting-edge contributions to several topics, including:
  • The documentation and classification of CDS malfunctions.
  • The co-design of patient care tools and the visualization of patient-reported outcome (PRO) data in support of shared decision making, critical areas that the CDSiC has also explored in its work.
Journal of the American Medical Informatics Association
A Scoping Review of Rule-Based Clinical Decision Support Malfunctions
This scoping review captured 130 CDS malfunctions, which were then coded according to an existing taxonomy. The review revealed the limited amount of literature documenting CDS malfunctions, and the ongoing need for existing taxonomies of CDS malfunctions to be updated.
jcm-logo
Implementation of a Co-Design Strategy to Develop a Dashboard to Support Shared Decision Making in Advanced Cancer and Chronic Kidney Disease
This article describes the process of patients, care partners, and clinicians codesigning a data visualization dashboard. The dashboard aimed to provide both clinicians and patients with timely, easily understandable information on the patient's health and preferences to support shared decision making, and was informed by PRO data. An evaluation of the codesign process revealed that it was successfully implemented.
Patient and Caregiver Perspectives on Generative Artificial Intelligence in Patient-Centered Clinical Decision Support

Developed by the AHRQ CDSiC Trust and Patient-Centeredness Workgroup, this report describes patient and caregiver perspectives on the use of generative AI in PC CDS, factors that impact trust in AI technology, and AI's impact on trust and the patient-clinician relationship, while providing specific considerations for the development and implementation of AI-supported PC CDS tools.
Inventory of Patient Preference Measurement Tools for PC CDS Report

Developed by the AHRQ CDSiC Measurement and Outcomes Workgroup, this inventory report describes an inventory that identifies specific patient preference measurement tools used in clinical settings and describes considerations and challenges to adopting and using patient preference measurement tools in practice. The accompanying filterable and sortable inventory spreadsheet provides details on the delivery method, context, and validity of each tool.
 
The Clinical Decision Support Innovation Collaborative (CDSiC) is a community of broad, diverse stakeholders at the forefront of using technology to better support care teams, patients, and caregivers. The CDSiC is working toward healthcare decisions that are driven by both patient-centered and patient-specific information and that align with patient needs, preferences, and values. The CDSiC is funded by the Agency for Healthcare Research and Quality (AHRQ) as part of a multi-component initiative to help advance patient-centered outcomes research into practice through CDS. For any inquiries regarding the CDSiC you may contact the project team at CDSiC@norc.org.

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc