Improving Glaucoma Care Using a Scalable Decision Support System

PROJECT SUMMARY/ABSTRACT Through the training outlined in this K23 award, Dr. Brian Stagg will become an independent investigator in health services research using health information technology to decrease glaucoma blindness by enhancing clinical decision making for glaucoma to ensure that patients receive appropriate glaucoma care.

CANDIDATE BACKGROUND: Dr. Stagg is an Assistant Professor specialized in glaucoma at the University of Utah. Following ophthalmology residency, he completed a 2-year health services research fellowship at the University of Michigan and earned a Master of Health and Healthcare Research degree, followed by a

glaucoma fellowship at Duke University. He has background experience in health services research, healthcare delivery research, data science, and biostatistics. CAREER DEVELOPMENT PLAN: To succeed as an independent investigator, Dr. Stagg needs additional training in: (1) Clinical Decision Support (CDS) system

workflow and implementation research, (2) CDS system design and human factors research, (3) CDS system EHR integration using health informatics standards, and (4) research leadership and grant writing. The training and mentorship outlined in this K23 will give Dr. Stagg this needed expertise. MENTORS: Through

the supportive research and mentorship environment at the University of Utah and his connections with mentors from the University of Michigan and Duke University, Dr. Stagg has put together an innovative interdisciplinary mentoring and advising team lead by Dr. Rachel Hess, his primary mentor. CLINICAL

PROBLEM: Up to 30% of patients who are actively treated for glaucoma continue to have significant visual field loss and need intensification of treatment to lower eye pressure and prevent further loss. Proper identification and management of such progressive visual field loss is vital to prevent blindness from

glaucoma. This is a challenge for clinicians caring for patients with glaucoma as they must incorporate large amounts of longitudinal data from many data sources accurately and efficiently. Optimized, workflow- appropriate CDS systems can help address this challenge. CDS systems present information to clinicians at the

point of care to improve decision making. SPECIFIC AIMS: Dr. Stagg will (Aim 1) understand differences between ophthalmologic specialists and generalists in glaucoma clinical decision-making workflow and workload, (Aim 2) iteratively refine the Glaucoma CDS System and evaluate its efficacy in a pre-clinical

setting, and (Aim 3) integrate the Glaucoma CDS System with the EHR and pilot for feasibility and usability in clinics to deliver personalized recommendations to clinicians for visual field testing frequency. The completion of these aims will result in (1) a rigorously developed, user-centered, scalable CDS system to help clinicians

determine a personalized visual field testing frequency for patients with glaucoma and (2) generalizable knowledge that will support future CDS development for glaucoma and other eye conditions.