title: Impact of an electronic medical record-based clinical decision support tool for dysphagia screening on care quality.
abstract: OBJECTIVE
  Dysphagia screening (DS) before oral intake in patients with acute stroke is a hospital-level performance measure. We report outcomes of an initiative to improve compliance to this quality measure.
  
  
  METHODS
  The design was a pre- versus postintervention comparison study. The Intervention was an electronic medical record-based clinical DS system embedded within stroke admission orders. The clinical DS was designed to facilitate DS in patients with stroke. The primary outcome was compliance to a process measure in patients with ischemic stroke: performance of a swallow screen before oral intake.
  
  
  RESULTS
  DS measure compliance increased from 36% to 74% (P=0.001). Chart audits found screened patients were more likely to have clinical DS-embedded admission orders initiated or stroke unit admission.
  
  
  CONCLUSIONS
  The electronic medical record offers a ready platform for clinical DS implementation. DS is a difficult performance measure to improve. The described clinical DS has the potential for improving performance on this challenging care quality measure.
authors.affiliation: Department of Neurology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA. laksh004@umn.edu
authors.forename: Kamakshi
authors.initials: K
authors.lastname: Lakshminarayan
authors.forename: Nassir
authors.initials: N
authors.lastname: Rostambeigi
authors.forename: Candace C
authors.initials: CC
authors.lastname: Fuller
authors.forename: James M
authors.initials: JM
authors.lastname: Peacock
authors.forename: Albert W
authors.initials: AW
authors.lastname: Tsai
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D057286:Electronic Health Records / Q000458:organization & administration* / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D008910:Minnesota; D011787:Quality of Health Care / Q000458:organization & administration*; D012042:Registries / Q000706:statistics & numerical data; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult