CDS Guidebook, Chapter 6: Selecting Interventions to Deliver Targeted Improvements

The tasks and key lessons for how to select specific interventions to deliver targeted improvements are listed below.

Tasks

• Use results from your objective-related care process mapping to build a shared understanding with stakeholders about the workflows – and related decision support needs and opportunities - pertinent to your selected improvement objective(s).
• Understand the five CDS Core Actions that help link your objective to specific intervention types and specific steps in the workflow that are likely to be effective in addressing it.
• Consider which Core Actions apply to your objective, and for each that does, examine intervention types and workflows to see which are relevant to objective-related care processes. Use Figures 6-1 through 6-3 for details and examples. (Worksheet 6-1)
• Chose specific interventions to address your objective based on implementation factors: ease of implementation, acceptability and impact – balancing these factors based on your organization’s CDS experience and resources. (Worksheets 6-2 and 6-3)

Key Lessons

• Five CDS “Core Actions” – recognizing patterns, formulating a plan, executing the plan, monitoring and responding to events, and communicating – broadly cover care delivery activities, and the ways in which information systems can augment this work. One or more Core Actions can be identified for a given clinical objective, and each Core Action is associated with CDS intervention types that can facilitate that action.
• Additionally, the Core Actions typically take place at different workflow points. If you understand which Core Actions drive performance on your objective, then you can identify not only some likely CDS intervention types to apply, but you can also identify when they should be applied.
• The better you understand how current care processes affect performance on your target objectives, the better able you will be to provide CDS interventions that improve outcomes. Often, the causes of high or low performance are multi-factorial, and in those cases a package of two or more interventions applied at different times can improve effectiveness more than just a single intervention.
• Each intervention type has its characteristic properties, such as how easy they are to implement, how acceptable users find them, and how effective they are at improving outcomes. When choosing among several intervention types that can address a given objective class, different organizations will have different optimal choices based on these properties.
• At this intervention selection stage, as at the subsequent stages outlined in the next chapters, it is vital to communicate your actions to key stakeholders and get their input into the planning and decisions.