Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDS

A randomized controlled trial

James M. Gill, Arch G. Mainous, Richelle J. Koopman, Marty S. Player, Charles J. Everett, Ying Xia Chen, James J. Diamond, Michael Lieberman

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)22-30
Number of pages9
JournalAnnals of Family Medicine
Volume9
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Clinical Decision Support Systems
Guideline Adherence
Electronic Health Records
Randomized Controlled Trials
Anti-Inflammatory Agents
Guidelines
Primary Health Care
Pharmaceutical Preparations
Quality of Health Care
Aspirin
Odds Ratio
Confidence Intervals
Peptic Ulcer
Anticoagulants
Patient Care
Adrenal Cortex Hormones

Keywords

  • Adverse effects
  • Clinical decision support
  • Digestive system (GI)
  • Electronic health record
  • Electronic medical record
  • Nonsteroidal anti-inflammatory drugs
  • Practicebased research
  • Primary care
  • Quality improvement

ASJC Scopus subject areas

  • Family Practice

Cite this

Gill, J. M., Mainous, A. G., Koopman, R. J., Player, M. S., Everett, C. J., Chen, Y. X., ... Lieberman, M. (2011). Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDS: A randomized controlled trial. Annals of Family Medicine, 9(1), 22-30. https://doi.org/10.1370/afm.1172

Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDS : A randomized controlled trial. / Gill, James M.; Mainous, Arch G.; Koopman, Richelle J.; Player, Marty S.; Everett, Charles J.; Chen, Ying Xia; Diamond, James J.; Lieberman, Michael.

In: Annals of Family Medicine, Vol. 9, No. 1, 01.2011, p. 22-30.

Research output: Contribution to journalArticle

Gill, JM, Mainous, AG, Koopman, RJ, Player, MS, Everett, CJ, Chen, YX, Diamond, JJ & Lieberman, M 2011, 'Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDS: A randomized controlled trial', Annals of Family Medicine, vol. 9, no. 1, pp. 22-30. https://doi.org/10.1370/afm.1172
Gill, James M. ; Mainous, Arch G. ; Koopman, Richelle J. ; Player, Marty S. ; Everett, Charles J. ; Chen, Ying Xia ; Diamond, James J. ; Lieberman, Michael. / Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDS : A randomized controlled trial. In: Annals of Family Medicine. 2011 ; Vol. 9, No. 1. pp. 22-30.
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abstract = "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.",
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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.

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