Life In The Slower Lane

Here is the PICO analysis for the eighteenth uploaded article:

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✅ PICO Analysis

Full Article Title:

Consensus-Derived Interventions to Reduce Acute Care Transfer (INTERACT)-Compatible Order Sets for Common Conditions Associated with Potentially Avoidable Hospitalizations

Type of Study:

Descriptive article detailing the development and implementation of expert-derived clinical decision support order sets

Journal and Year:

Journal of the American Medical Directors Association (JAMDA), 2015; 16(7):524–526

DOI: 10.1016/j.jamda.2015.02.016

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P – Population

• Setting:
  • Nursing homes and other long-term and post-acute care settings across the United States
• Target Population:
  • Older adults, particularly nursing home residents who are at risk of potentially avoidable hospitalizations
• Healthcare Professionals Involved:
  • Physicians, nurse practitioners, physician assistants, and nursing staff 

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I – Intervention

• Nature of Intervention:
  • Development and implementation of INTERACT-compatible order sets for common acute conditions
  • Ten standardised order sets created for conditions responsible for most potentially avoidable hospitalisations:
    1. Pneumonia
    2. Congestive heart failure
    3. Urinary tract infection
    4. Dehydration/acute kidney injury
    5. Chronic obstructive pulmonary disease/asthma6–10. (Not fully listed in the article but referenced via INTERACT-compatible care paths)
• Features of the Order Sets:
  • Based on best available evidence and expert consensus
  • Customisable for local use
  • Include menus of nursing, diagnostic, and treatment orders
  • Integrated prompts, default orders, visual alerts, and free-text fields (see Figure 1 on page 2)
  • Designed for use on paper or embedded in electronic medical record (EMR) systems 

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C – Comparison

• Comparator:
  • Not a comparative trial—this is a descriptive and implementation paper
  • Implicit comparison is between usual care (without standardised decision support tools) versus use of structured INTERACT-compatible order sets
• Rationale for Development:
  • Existing resources lacked point-of-care tools to assist with physician-led decision-making for acute changes in condition

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O – Outcomes

Proposed/Anticipated Outcomes (based on literature and rationale):

1. Process Improvements:
   • Standardisation of acute care responses
   • More consistent use of evidence-based clinical decision-making
   • Improved staff confidence and communication during acute changes in condition
2. Health System Outcomes:
   • Fewer potentially avoidable hospitalisations
   • Reduction in emergency department visits
   • Decreased treatment variability
   • Reduced adverse events (e.g., from inappropriate or delayed treatments)
   • Potential cost savings (between $625 million and $2.9 billion annually if 20–60% of relevant admissions are prevented) 
3. Implementation Context:
   • Order sets were refined by a multidisciplinary expert panel and made available via the Think Research platform
   • Order sets aligned with INTERACT care paths and can be integrated into existing EMRs for automated clinical support

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Outcome Classification

• Person-centred outcomes: Indirect—by reducing unnecessary transfers, residents may experience greater continuity, comfort, and stability
• Process outcomes: Enhanced standardisation, improved clinical communication, rapid decision-making, increased uptake of INTERACT protocols
• Health system outcomes: Lower avoidable hospitalisation rates, potential reduction in readmissions, better clinical quality indicators, financial incentives under CMS policy

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Summary Conclusion

This article outlines the development of consensus-based, INTERACT-compatible order sets for managing common acute conditions in nursing homes. The order sets fill a critical gap in the INTERACT framework by providing ready-to-use, evidence-informed clinical decision support tools. Designed to be integrated into workflows or EMRs, these tools aim to enhance quality of care, reduce unnecessary hospital transfers, and align with CMS quality initiatives. Early use cases suggest feasibility and relevance, but empirical evaluation of outcomes was not reported in this paper .

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