Project Details - Ended
- Grant Number:R01 HS015169
- Funding Mechanism:
- AHRQ Funded Amount:$1,153,892
- Principal Investigator:
- Project Dates:9/30/2004 to 9/29/2009
- Care Setting:
- Medical Condition:
- Type of Care:
- Health Care Theme:
Computer-based clinical decision support (CDS) systems are health information tools that combine education, physician participation, and feedback via reminders. These technologies have the potential to change physician behavior at the precise time that clinical decisions are being made. However, such systems are still not used broadly, and the full potential of CDS systems and tools remains to be tested.
Issues of usability and integration into the clinicians' workflow are two key barriers to the effectiveness of CDS tools. One potential solution under development at Partners HealthCare is to integrate decision support into clinical documentation templates or Smart Forms (SFs), facilitating clinical decision support, ordering, patient education, and documentation in a single step. These SF tools can also facilitate the acquisition of key quality data that can then be presented in a Quality Dashboard (QD), a tool that tracks statistical data about patient care and presents a comparative analysis across various groups to the user. If linked to the electronic health record (EHR), QDs can enhance feedback by providing actionable, population-based information on quality of care, facilitate adherence to guidelines, and identify patients most in need of attention. To date, very few EHRs have developed such features and functions.
The purpose of this project was to design and implement SF and QD tools and to assess their impact on guideline adherence in three clinical areas: acute respiratory tract infections (ARI), coronary artery disease (CAD), and diabetes mellitus (DM). The study encompassed 27 primary care clinics and over 400 clinicians associated with Bringham and Women's and Massachusetts General Hospital, all part of the Partners HealthCare System.
Four randomized, controlled trials were conducted, preceded by smaller scale pilot studies. The main study compared usual care to use of SF alone, and to use of SF plus QD. Outcome measures were compared between the intervention and control practices. The ARI SF study revealed a small but significant difference in antibiotic prescribing rates, with clinicians prescribing antibiotics to 43 percent of ARI patients in control clinics and 39 percent of ARI patients in intervention clinics. CAD/DM SF and CAD/DM QD data are being analyzed. Survey results indicate that exposure to new CDS tools may marginally increase adherence to clinical guidelines. In addition, most users found the tools intuitive to use, easy to integrate into clinicians' workflow, and beneficial in terms of quality of patient care.