108 - The Role of Online Decision Support in Improving Outcomes: A Meta-Analysis of 20 Tools Spanning 5+ Years of Practice

Health Care Problem

The rapid introduction of multilple new therapeutic options in fields such as Hematology/Oncology has made it challenging for
clinicians to make treatment decisions that account for all recent relevant data. While guidelines help clinicians identify a broad group of treaments or regimens that may be appropriate, guidelines typically do not offer specific guidance on how individual treatment options may apply to a specific patient. Accordingly, our group has developed an extensive series of expert-authored online, interactive decision support tools. For the first time, we have undertaken a comprehensive meta-analysis of outcomes data from these tools to determine their impact on clinical practice.

Educational Strategy

For each individual tool, a group of experts (typically 5) supply data points that map to all possible patient permutations (eg, age,
performance status, prior treatment). Those data are developed into a comprehensive tool that is published online. Clinicians who use
the tool enter data for one patient, and in return, they receive a customized report showing exactly how experts would treat that
patient. We used Structured Query Language (SQL) to extract participation and outcomes data from a series of 37 tools published to
date and used standard data analysis techniques to evaluate individual program metrics such as unique visits, number of cases entered,
and learner-reported impact on practice.

Patient-Level Outcome(s) Measured

More than 31,000 individual clinicians have used the decision support tools to evaluate specific patient cases. We conservatively
estimate that 36,900 patients have benefited from clinician particiption in the tool, directly or indirectly. While more comprehensive
analyses are ongoing, the most recent tool data indicate that 31% to 55% of users report using the tool to get treatment advice on an
actual patient in their practice (as opposed to a hypothetical patient case entered to improve knowledge). In nearly half of cases
(preliminarily: 41%), learners report that their practice was changed by the expert results they received through the tools. Moreover,
our most recent analyses of tool data vs electronic medical record (EMR) data suggest that the tool data reflects the real world: for a
number of common case presentations, the gap in optimal practice, defined as the number of suboptimal choices entered before
receiving expert advice, closely mirrors the rate of suboptimal treatment choices entered in EMR (N = 247 EMR records). These
results, which will be updated for the ACEHP 2018 Annual Meeting, suggest that online decision support tools, when properly
implemented, can change practice, impact real patients, and reflect real world practice.

Kevin Obholz

Editorial Director
Clinical Care Options, LLC
Prosper, Texas

Kevin Obholz, PhD is the Editorial Director- Hematology/Oncology for Clinical Care Options, LLC. For nearly 25 years he has been fully committed to medical research and education, and during his 11-year tenure at Clinical Care Options has designed and managed the content development for hundreds of successful CME-certified educational programs. He has served as the Editorial Director at Clinical Care Options since 2013 and leads a team of highly educated and trained editors who are fully committed to producing education that improves the care of patients with cancer. Finally, Kevin and CCO focus on the dissemination of data that advances the understanding of ongoing educational and medical needs in cancer care and over the last 5 years he has authored or co-authored 20 education-focused peer-reviewed papers, posters and oral presentations (most in collaboration with leading oncology/hematology experts).