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Nemours receives Dept. of Defense award to study physicians' maintenance of optimal clinical program

Jacksonville, Fla. (Nov. 12, 2013) The Department of Defense has awarded Nemours a $3.9 million grant to evaluate how physicians use best practice guidelines and to consider strategies to maintain clinical skills and consistency of care. The study, which will examine care provided throughout Nemours' pediatric health system, could help the military reintegrate physicians after deployment and better understand how their time away from routine practice affects their clinical knowledge and skill.

The trial will first use observational tracking followed by randomized trials of interventions over a three-year period. Using Nemours' comprehensive electronic medical records, researchers will assess how the frequency with which doctors treat a particular condition influences their care decisions, in comparison to best practice guidelines. This work will be done in collaboration with Lockheed Martin, which has significant experience in measuring and mitigating the decline of skills among aircraft pilots.

"While the art of medicine must allow for certain flexibility and professional judgment, helping physicians maintain consistency with best practice guidelines through decision support or other interventions should improve the quality of care," said Tim Wysocki, Ph.D., co-director of the Center for Healthcare Delivery Science with Nemours. "We are extremely fortunate that the Department of Defense is giving us this opportunity to look at how physicians can maintain peak performance whether in the military or domestic practice."

Past studies have shown that physicians who return to domestic practice after long deployments overseas may exhibit a mild loss of some sophisticated clinical skills. The Department of Defense hopes to learn whether less exposure to certain medical conditions contributes to this finding and to test ways of reducing the effect.

Nemours' has developed a robust electronic medical record system which will be used for this effort. In use for more than 15 years, with data on more than 400 physicians at facilities in Delaware, Florida, Pennsylvania and New Jersey, the system has been progressively refined for each clinical division throughout Nemours and can target specific quality of care measures for common conditions.

Researchers will analyze these electronic medical records for patterns in physicians' types of cases and their variability in practice for certain targeted medical conditions. Ultimately, the study will test interventions to help minimize such variation, such as including feedback alerts in the electronic medical records to provide decision support for physicians.

"We need to learn how doctors forget," said Thomas Talbot, MD, TATRC Medical Simulation Leader. "By working with Nemours, we will learn about factors that allow us to tune retraining and ongoing medical education to each doctor and their unique patient population."


Contact: Erin Wallner

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