Background: Electronic clinical decision support (ECDS) tools are often developed within quality improvement (QI) projects to increase adherence with the latest clinical practice guidelines (CPGs).However, scalability and sustainability of ECDS beyond the time and location of their associated project are very limited. Deploying ECDS using a mobile app (mECDS) has shown the potential to be a viable method of overcoming these limitations. However, it is unclear what pattern the spread of uptake and use of such a tool might follow.
Methods: In 2016, our team released a freely available mECDS as part of a national multi-site project entitled Reducing Variation in Infant Sepsis Evaluation (REVISE). For this study, we evaluated trends in weekly mECDS usage measures defined as 1) REVISE metric related screen views (MetricHits), 2) unique designated market areas (DMA) where the mECDS was used (Unique DMAs), 3) density of use or MetricHits/Unique DMAs (HitsPerDMA). Linear regressions were performed to examine the app usage trends measures across three time periods (during REVISE, 1-year post, 2-year post). Separate regression analyses were performed among DMAs that contained a REVISE site and those that did not. The number of REVISE sites in the DMA, the number of children’s hospitals in the DMA, DMA population, and season were also evaluated as confounding factors.
Results: Strong growth in the number of unique DMAs and MetricHits occurred during the period of 1-year post the REVISE project. The overall usage continued to be relatively stable during the period of 2-years post. HitsPerDMA had stronger growth in DMAs with a REVISE site than those without. MetricHits were higher in DMAs with a larger population, more REVISE sites, and more children’s hospitals. There were also more MetricHits in the summer than in the winter months.
Conclusions: Both temporal and spatial increases in mECDS app usage were found as evidence of a contagion method of spread. Other confounding factors may also play a role in app reach, adoption, and sustainability. Further research is needed to determine the factors driving passive diffusion and its impact on clinical practice and patient outcomes.