{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:55:03Z","timestamp":1792799703844,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100002799","name":"Intermountain Healthcare Office of Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002799","id-type":"DOI","asserted-by":"publisher"},{"id":"https:\/\/ror.org\/04mvr1r74","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Intermountain Healthcare Office of Research","id":[{"id":"https:\/\/ror.org\/04mvr1r74","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Care of emergency department (ED) patients with pneumonia can be challenging. Clinical decision support may decrease unnecessary variation and improve care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To report patient outcomes and processes of care after deployment of electronic pneumonia clinical decision support (ePNa): a comprehensive, open loop, real-time clinical decision support embedded within the electronic health record.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a pragmatic, stepped-wedge, cluster-controlled trial with deployment at 2-month intervals in 16 community hospitals. ePNa extracts real-time and historical data to guide diagnosis, risk stratification, microbiological studies, site of care, and antibiotic therapy. We included all adult ED patients with pneumonia over the course of 3 years identified by International Classification of Diseases, 10th Revision discharge coding confirmed by chest imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>The median age of the 6,848 patients was 67 years (interquartile range, 50\u201379), and 48% were female; 64.8% were hospital admitted. Unadjusted mortality was 8.6% before and 4.8% after deployment. A mixed effects logistic regression model adjusting for severity of illness with hospital cluster as the random effect showed an adjusted odds ratio of 0.62 (0.49\u20130.79; P\u2009&amp;lt;\u20090.001) for 30-day all-cause mortality after deployment. Lower mortality was consistent across hospital clusters. ePNa-concordant antibiotic prescribing increased from 83.5% to 90.2% (P\u2009&amp;lt;\u20090.001). The mean time from ED admission to first antibiotic was 159.4 (156.9\u2013161.9) minutes at baseline and 150.9 (144.1\u2013157.8) minutes after deployment (P\u2009&amp;lt;\u20090.001). Outpatient disposition from the ED increased from 29.2% to 46.9%, whereas 7-day secondary hospital admission was unchanged (5.2% vs. 6.1%). ePNa was used by ED clinicians in 67% of eligible patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ePNa deployment was associated with improved processes of care and lower mortality.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT03358342).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202109-2092oc","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T11:26:36Z","timestamp":1646738796000},"page":"1330-1336","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":32,"title":["A Pragmatic, Stepped-Wedge, Cluster-controlled Clinical Trial of Real-Time Pneumonia Clinical Decision Support"],"prefix":"10.1093","volume":"205","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1996-0533","authenticated-orcid":false,"given":"Nathan C.","family":"Dean","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine"},{"name":"Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline G.","family":"Vines","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, LDS Hospital, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason R.","family":"Carr","sequence":"additional","affiliation":[{"name":"Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna G.","family":"Rubin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1799-3315","authenticated-orcid":false,"given":"Brandon J.","family":"Webb","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Intermountain Healthcare, Salt Lake City, Utah"},{"name":"Division of Infectious Diseases and Geographic Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason R.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Office of Research, Intermountain Medical Center, Murray, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison M.","family":"Butler","sequence":"additional","affiliation":[{"name":"Office of Research, Intermountain Medical Center, Murray, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaehoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Office of Research, Intermountain Medical Center, Murray, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Al R.","family":"Jephson","sequence":"additional","affiliation":[{"name":"Office of Research, Intermountain Medical Center, Murray, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Jenson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, St. George Regional Medical Center, St. George, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Missy","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Utah Valley Regional Medical Center, Provo, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1206-6261","authenticated-orcid":false,"given":"Samuel M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine"},{"name":"Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy A.","family":"Irvin","sequence":"additional","affiliation":[{"name":"Department of Computer Science, Stanford University, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew P.","family":"Lungren","sequence":"additional","affiliation":[{"name":"Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, California; 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