# Evaluation of the SCALED (SCaling AcceptabLE cDs) Approach for the Implementation of Interoperable CDS for Venous Thromboembolism Prevention

> **NIH AHRQ R18** · UNIVERSITY OF MINNESOTA · 2022 · $985,383

## Abstract

ABSTRACT/PROJECT SUMMARY
There is a global emphasis and critical need to close the patient-centered outcomes research (PCOR) evidence
to practice gap. Forty percent of patients do not receive evidence-based practice, 20% receive unnecessary or
potentially harmful care, and sadly, the list continues. We believe interoperable clinical decision support (CDS)
is an indispensable solution to help close this gap; however, poor design, lack of interoperability, and
implementation barriers hinder broad adoption. At the University of Minnesota, we have extensive experience
implementing and scaling user-centered CDS systems, with over 20 use cases scaled each year. Importantly,
we have developed and implemented both interoperable and federally-funded CDS systems. Our healthcare
system leverages a rigorous approach, SCALED (SCaling AcceptabLE cDs), to guide CDS scaling across the
system. But, the current climate of each healthcare system developing “home-grown” CDS for the exact same
guidelines is not tenable. Building capabilities to rapidly translate PCOR to the bedside at scale and share
interoperable CDS routinely with an updated knowledge base (living evidence synthesis) is necessary. Given
this, we partnered with Apervita, developers of a healthcare technology platform for digital quality measurement
and decision support, to develop an interoperable clinical practice guideline leveraging CPG-on-FHIR (Fast
Healthcare Interoperability Resources) to prevent inpatient COVID-19 venous thromboembolism (VTE).
The proposed R18 project will adapt a currently deployed CDS system to also deliver a VTE prevention guideline
for adult patients with traumatic brain injury (TBI). We believe this is an ideal PCOR use case given PCORI’s
continued effort to combat VTE in trauma and our experience previously implementing this guideline.
Our overall goal is to successfully scale, evaluate, and maintain an interoperable TBI CDS across our 4-institution
collaborative network. For Aim 1, we will conduct a Hybrid Type 2 randomized stepped wedge effectiveness-
implementation trial to scale the CDS across 4 heterogeneous healthcare systems. Trial outcomes will be
assessed using RE-AIM. Despite best efforts, it highly likely CDS adoption will vary across each site; Aim 2 will
allow us to understand why. In Aim 2, we will evaluate implementation processes across trial sites guided by the
EPIS implementation framework (determinant framework) using mixed-methods. Finally, it is critical that PCOR
CPGs are maintained as evidence evolves. To date an accepted process for evidence maintenance does not
exist. In Aim 3, we will pilot a “Living Guideline” process model for the VTE prevention CDS systems.
Ultimately, this project will scale CDS across a diverse collaborative CDS community serving as an important
demonstration of this critical healthcare challenge. We will integrate lessons learned for a planned national
scaling in collaboration with engagement of U.S. trauma societies. Imp...

## Key facts

- **NIH application ID:** 10494692
- **Project number:** 1R18HS028583-01A1
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** Genevieve B Melton-Meaux
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $985,383
- **Award type:** 1
- **Project period:** 2022-08-05 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10494692

## Citation

> US National Institutes of Health, RePORTER application 10494692, Evaluation of the SCALED (SCaling AcceptabLE cDs) Approach for the Implementation of Interoperable CDS for Venous Thromboembolism Prevention (1R18HS028583-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10494692. Licensed CC0.

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