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OBJECTIVE: Our objective was to develop an evaluation framework for electronic health record (EHR)-integrated innovations to support evaluation activities at each of four information technology (IT) life cycle phases: planning, development, implementation, and operation. METHODS: The evaluation framework was developed based on a review of existing evaluation frameworks from health informatics and other domains (human factors engineering, software engineering, and social sciences); expert consensus; and real-world testing in multiple EHR-integrated innovation studies. RESULTS: The resulting Evaluation in Life Cycle of IT (ELICIT) framework covers four IT life cycle phases and three measure levels (society, user, and IT). The ELICIT framework recommends 12 evaluation steps: (1) business case assessment; (2) stakeholder requirements gathering; (3) technical requirements gathering; (4) technical acceptability assessment; (5) user acceptability assessment; (6) social acceptability assessment; (7) social implementation assessment; (8) initial user satisfaction assessment; (9) technical implementation assessment; (10) technical portability assessment; (11) long-term user satisfaction assessment; and (12) social outcomes assessment. DISCUSSION: Effective evaluation requires a shared understanding and collaboration across disciplines throughout the entire IT life cycle. In contrast with previous evaluation frameworks, the ELICIT framework focuses on all phases of the IT life cycle across the society, user, and IT levels. Institutions seeking to establish evaluation programs for EHR-integrated innovations could use our framework to create such shared understanding and justify the need to invest in evaluation. CONCLUSION: As health care undergoes a digital transformation, it will be critical for EHR-integrated innovations to be systematically evaluated. The ELICIT framework can facilitate these evaluations.

Background: Hemiarthroplasty is a common treatment for displaced femoral neck fractures, but limited Canadian data are available about hemiarthroplasty failure. We evaluated the frequency and predictors of hemiarthroplasty failure in Manitoba. Methods: In this retrospective multicentre province-wide study, billing and joint registry databases showed 4693 patients who had hemiarthroplasty for treatment of femoral neck fracture in Manitoba over an 11-year period (2005-2015), including 155 hips with subsequent reoperations (open or closed) for treatment of hemiarthroplasty failure. Hospital records were reviewed to identify modes of hemiarthroplasty failure, comorbidities and reoperations. Data were analyzed using [chi square] test and Poisson and y regression models. Results: During our study period, 155 hips (154 patients [3%]) underwent 230 reoperations. Of these, 131 hips (85%) initially had an uncemented unipolar modular implant. Indications for first-time reoperation included periprosthetic femur fracture (49 hips [32%]), dislocation (45 hips [29%]), acetabular wear (28 hips [18%]) and infection (26 hips [17%]). There were 46 hips (30%) that had 2 or more reoperations. Reoperation for dislocation was associated with presence of dementia; acetabular wear was associated with absence of dementia. Time from hemiarthroplasty to reoperation was associated inversely with age at hemiarthroplasty, dislocation and dementia and was directly associated with acetabular wear. The risk of having 2 or more reoperations was associated independently with dislocation, infection, and alcohol abuse. Conclusion: Hemiarthroplasty for femoral neck fracture in Manitoba had a low frequency of failure. Risk factors for multiple reoperations included dislocation, infection and alcohol abuse. Contexte : L'hemiarthroplastie est un traitement courant pour les fractures deplacees du col femoral, mais on dispose de peu de donnees canadiennes au sujet de l'echec de cette intervention. Nous avons evalue la frequence et les predicteurs de l'echec de l'hemiarthroplastie au Manitoba. Methodes : Pour cette etude retrospective multicentrique menee a l'echelle de la province, les bases de donnees de facturation et les registres orthopediques ont montre que 4693 patients avaient subi une hemiarthroplastie pour le traitement d'une fracture du col femoral au Manitoba sur une periode de 11 ans (2005-2015), dont 155 hanches qui ont par la suite du etre reoperees (intervention ouverte ou fermee) pour le traitement d'un echec de l'hemiarthroplastie. On a passe en revue les dossiers hospitaliers pour identifier les types d'echec de l'intervention, les comorbidites et les reinterventions. Les donnees ont ete analysees a l'aide du test du [chi square] et des modeles de Poisson et de regression en y. Resultats : Durant la periode de notre etude, 155 hanches (154 patients [3 %]) ont subi 230 reinterventions. Parmi elles, 131 hanches (85 %) ont recu un implant modulaire unipolaire non cimente. Les indications d'une premiere reintervention incluaient fracture du femur periprothetique (49 hanches [32 %]), dislocation (45 hanches [29 %]), usure acetabulaire (28 hanches [18 %]) et infection (26 hanches [17 %]). Quarante-six hanches (30 %) ont du faire l'objet de 2 reinterventions ou plus. La reintervention pour dislocation a ete associee a la presence de demence; l'usure acetabulaire a ete associee a l'absence de demence. L'intervalle entre l'hemiarthroplastie et la reintervention etait inversement associe a l'age au moment de l'hemiarthroplastie, a la dislocation et a la demence, et directement associe a l'usure acetabulaire. Le risque de subir 2 reinterventions ou plus etait independamment associe a la dislocation, a l'infection et a la consommation d'alcool. Conclusion : L'hemiarthroplastie pour les fractures du col femoral au Manitoba a connu un faible taux d'echec. Les facteurs de risque a l'egard des reinterventions incluaient la dislocation, l'infection et la consommation d'alcool., Acute displaced intracapsular femoral neck fractures comprise almost half of all hip fractures, and most of these fractures in elderly patients in the developed world are treated surgically with hip [...]

Objectives Despite known health benefits of breastfeeding, the Navajo have low reported frequency of breastfeeding initiation and support. We evaluated breastfeeding frequencies and practices in the predominately Navajo community of rural San Juan County, Utah, to identify factors that affect breastfeeding decisions and duration. Methods We performed retrospective chart review for 135 infants aged 0 to 12 months, and surveys of 85 mothers of infants aged 0 to 2 years, and eight primary care providers. We characterized demographic factors using counts/percentages and medians/inter-quartile ranges, and compared mothers who breastfed for 6 months or less versus greater than 6 months. Results In 96 infants with complete feeding documentation, 86 infants (90%) received some breast milk and 36 infants (38%) were exclusively breastfed at age 2 months. In 67 infants with complete feeding documentation at [greater than or equal to] 6 months, 22 infants (33%) were exclusively breastfed 6 months. Most mothers knew about breastfeeding benefits. In 56 mothers whose infants were aged [greater than or equal to] 6 months at the time of the survey, breastfeeding for more than 6 months had been planned by 44 mothers (79%) but performed by only 29 mothers (52%). Mothers who breastfed for > 6 months were more likely to have been influenced by WIC and less likely to have introduced formula at an early age. Barriers to breastfeeding included maternal pain, latch difficulties, and concerns about inadequate milk supply. Primary care providers reported limited confidence in providing breastfeeding support but would support telehealth-driven interventions. Conclusions for Practice Practical, culturally sensitive interventions, including telehealth and improved provider education, may improve breastfeeding outcomes and community health in this underserved population., Author(s): Laura L. Brown [sup.1] , Revina Talker [sup.2] , Gregory J. Stoddard [sup.3] , Jessica Clayton [sup.1] , Morgan M. Millar [sup.4] , Yeonjung Jo [sup.5] , Tyler Bardsley [...]

In 2011, an expert National Institutes of Health panel published the “Integrated Guidelines for CV Health and Risk Reduction in Children and Adolescents,” which recommended screening all children aged 9 to 11 years for dyslipidemia. It is unknown if this guideline is being followed. We surveyed members of the Utah chapter of the American Academy of Pediatrics to determine whether they performed universal lipid screening at well-child visits (WCV) on their patients at 9,10, or 11 years and how comfortable they were with evaluating and/or managing children with dyslipidemia. Of the 118 respondents who practiced primary care, only 18 (15%) screened all children at WCV; 86 (73%) tested “some,” most commonly children who were obese or had a positive family history. 18% were unfamiliar with the guidelines; 28% were familiar with the guidelines but felt they were “inappropriate;” 98 (84%) of the respondents said they were “very or somewhat comfortable” evaluating children with dyslipidemia. [ABSTRACT FROM AUTHOR]

There is limited guidance available in the literature for establishing clinical decision support (CDS) governance and improving CDS effectiveness in a pragmatic, resource-efficient manner. Here, we describe how University of Utah Health established enterprise CDS governance in 2015 leveraging existing resources. Key components of the governance include a multi-stakeholder CDS Committee that vets new requests and reviews existing content; a requirement that proposed CDS is actually desired by intended recipients; coordination with other governance bodies; basic data analytics to identify high-frequency, low-value CDS and monitor progress; active solicitation of user issues; the transition of alert and reminder content to other, more appropriate areas in the electronic health record; and the judicious use of experimental designs to guide decision-making regarding CDS effectiveness. In the three years since establishing this governance, new CDS has been continuously added while the overall burden of clinician-facing alerts and reminders has been reduced by 53.8%.