Computerized Advisory Decision Support for Cardiovascular Diseases in Primary Care: A Cluster Randomized Trial - 19/06/20
, Daryl J. Kor, MD b, c, David A. Cook, MD, MHPE d, e, Maya E. Kessler, MD, MPH f, Rickey E. Carter, PhD b, g, Patrick M. Wilson, MPH g, Laurie J. Pencille, CCRP b, d, Branden C. Hickey, BS, MAS d, Rajeev Chaudhry, MBBS, MPH d, fABSTRACT |
Purpose |
The purpose of this research was to evaluate the impact of an outpatient computerized advisory clinical decision support system (CDSS) on adherence to guideline-recommended treatment for heart failure, atrial fibrillation, and hyperlipidemia.
Methods |
Twenty care teams (109 clinicians) in a primary care practice were cluster-randomized to either access or no access to an advisory CDSS integrated into the electronic medical record. For patients with an outpatient visit, the CDSS determined if they had heart failure with reduced ejection fraction, hyperlipidemia, or atrial fibrillation; and if so, was the patient receiving guideline-recommended treatment. In the intervention group, an alert was visible in the medical record if there was a discrepancy between current and guideline-recommended treatment. Clicking the alert displayed the treatment discrepancy and recommended treatment. Outcomes included prescribing patterns, self-reported use of decision aids, and self-reported efficiency. The trial was conducted between May 1 and November 15, 2016, and incorporated 16,310 patient visits.
Results |
The advisory CDSS increased adherence to guideline-recommended treatment for heart failure (odds ratio [OR] 7.6, 95% confidence interval [CI], 1.2, 47.5) but had no impact in atrial fibrillation (OR 0.94, 95% CI 0.15, 5.94) or hyperlipidemia (OR 1.1, 95% CI 0.6, 1.8). Clinicians with access to the CDSS self-reported greater use of risk assessment tools for heart failure (3.6 [1.1] vs 2.7 [1.0], mean [standard deviation] on a 5-point scale) but not for atrial fibrillation or hyperlipidemia. The CDSS did not impact self-assessed efficiency. The overall usage of the CDSS was low (19%).
Conclusions |
A computerized advisory CDSS improved adherence to guideline-recommended treatment for heart failure but not for atrial fibrillation or hyperlipidemia.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Clinical decision support, Electronic medical record, Heart failure, Hyperlipidemia
Plan
| Funding: This work was supported by the Office of Information and Knowledge Management and Center for the Science of Health Care Delivery at Mayo Clinic. |
|
| Conflicts of Interest: None. |
|
| Authorship: All authors had access to the data and a role in writing this manuscript. |
|
| Trial Registration: clinicaltrials.gov. Identifier: NCT02742545. |
Vol 133 - N° 6
P. 750 - juin 2020 Retour au numéro
Article précédent
- Financial Incentives for Smoking Cessation in Hospitalized Patients: A Randomized Clinical Trial
- Joseph A. Ladapo, Chi-Hong Tseng, Scott E. Sherman
- Opportunities and Challenges of Disruptive Innovation in Medicine Using Artificial Intelligence
- Rinku Skaria, Pratik Satam, Zain Khalpey
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?