TY - JOUR
T1 - Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDS
T2 - A randomized controlled trial
AU - Gill, James M.
AU - Mainous, Arch G.
AU - Koopman, Richelle J.
AU - Player, Marty S.
AU - Everett, Charles J.
AU - Chen, Ying Xia
AU - Diamond, James J.
AU - Lieberman, Michael I.
N1 - Funding Information:
Conflicts of interest: This study was funded by AstraZeneca Pharmaceuticals. The funder participated in discussions regarding study design and protocol development but did not significantly participate in decisions regarding these issues. The investigators had full responsibility for all other aspects of the study
Funding Information:
Funding support: This study was funded by AstraZeneca Pharmaceuticals.
PY - 2011
Y1 - 2011
N2 - PURPOSE Electronic health records (EHRs) with clinical decision support hold promise for improving quality of care, but their impact on management of chronic conditions has been mixed. This study examined the impact of EHR-based clinical decision support on adherence to guidelines for reducing gastrointestinal complications in primary care patients on nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS This randomized controlled trial was conducted in a national network of primary care offices using an EHR and focused on patients taking traditional NSAIDs who had factors associated with a high risk for gastrointestinal complications (a history of peptic ulcer disease; concomitant use of anticoagulants, antiplatelet medications [including aspirin], or corticosteroids; or an age of 75 years or older). The offices were randomized to receive EHR-based guidelines and alerts for high-risk patients on NSAIDs, or usual care. The primary outcome was the proportion of patients who received guideline-concordant care during the 1-year study period (June 2007-June 2008), defined as having their traditional NSAID discontinued (including a switch to a lower-risk medication), having a gastroprotective medication coprescribed, or both. RESULTS Participants included 27 offices with 119 clinicians and 5,234 highrisk patients. Intervention patients were more likely than usual care patients to receive guideline-concordant care (25.4% vs 22.4%, adjusted odds ratio = 1.19; 95% confidence interval, 1.01-1.42). For individual high-risk groups, patients on low-dose aspirin were more likely to receive guideline-concordant care with the intervention vs usual care (25.0% vs 20.8%, adjusted odds ratio = 1.30; 95% confidence interval, 1.04-1.62), but there was no significant difference for patients in other high-risk groups. CONCLUSIONS This study showed only a small impact of EHR-based clinical decision support for high-risk patients on NSAIDs in primary care offices. These results add to the growing literature about the complexity of EHR-based clinical decision support for improving quality of care.
AB - PURPOSE Electronic health records (EHRs) with clinical decision support hold promise for improving quality of care, but their impact on management of chronic conditions has been mixed. This study examined the impact of EHR-based clinical decision support on adherence to guidelines for reducing gastrointestinal complications in primary care patients on nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS This randomized controlled trial was conducted in a national network of primary care offices using an EHR and focused on patients taking traditional NSAIDs who had factors associated with a high risk for gastrointestinal complications (a history of peptic ulcer disease; concomitant use of anticoagulants, antiplatelet medications [including aspirin], or corticosteroids; or an age of 75 years or older). The offices were randomized to receive EHR-based guidelines and alerts for high-risk patients on NSAIDs, or usual care. The primary outcome was the proportion of patients who received guideline-concordant care during the 1-year study period (June 2007-June 2008), defined as having their traditional NSAID discontinued (including a switch to a lower-risk medication), having a gastroprotective medication coprescribed, or both. RESULTS Participants included 27 offices with 119 clinicians and 5,234 highrisk patients. Intervention patients were more likely than usual care patients to receive guideline-concordant care (25.4% vs 22.4%, adjusted odds ratio = 1.19; 95% confidence interval, 1.01-1.42). For individual high-risk groups, patients on low-dose aspirin were more likely to receive guideline-concordant care with the intervention vs usual care (25.0% vs 20.8%, adjusted odds ratio = 1.30; 95% confidence interval, 1.04-1.62), but there was no significant difference for patients in other high-risk groups. CONCLUSIONS This study showed only a small impact of EHR-based clinical decision support for high-risk patients on NSAIDs in primary care offices. These results add to the growing literature about the complexity of EHR-based clinical decision support for improving quality of care.
KW - Adverse effects
KW - Clinical decision support
KW - Digestive system (GI)
KW - Electronic health record
KW - Electronic medical record
KW - Nonsteroidal anti-inflammatory drugs
KW - Practicebased research
KW - Primary care
KW - Quality improvement
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U2 - 10.1370/afm.1172
DO - 10.1370/afm.1172
M3 - Article
C2 - 21242557
AN - SCOPUS:78951489743
SN - 1544-1709
VL - 9
SP - 22
EP - 30
JO - Annals of family medicine
JF - Annals of family medicine
IS - 1
ER -