Apkon M et al. 2005 "A randomized outpatient trial of a decision-support information technology tool."

Apkon M, Mattera JA, Lin ZQ, et al. A randomized outpatient trial of a decision-support information technology tool. Arch Intern Med 2005;165(20):2388-2394.
"Background: Decision-support information technology is often adopted to improve clinical decision making, but it is rarely rigorously evaluated. Congress mandated the evaluation of ... a decision-support tool. proposed for the Department of Defense's new health information network. Methods: This was a patient-level randomized trial conducted at 2 military practices. A total of 936 patients were allocated to the intervention group and 966 to usual care. [The decision support system (DSS) was] applied before routine ambulatory clinic visits. The primary outcome was quality of care, which was assessed based on the total percentage of any of 24 health care quality process measures (opportunities to provide evidence-based care) that were fulfilled. Secondary outcomes included medical resources consumed within 60 days of enrollment and patient and provider satisfaction. Results: There were 4639 health care opportunities (2374 in the [DSS] group and 2265 in the usual-care group), with no difference in the proportion of opportunities fulfilled (33.9% vs 30.7%; P = .12). Although there was a modest improvement in performance on screening/preventive measures, it was offset by poorer performance on some measures of acute care. [DSS group] patients used more laboratory and pharmacy resources than usual-care patients (logarithmic mean difference, $71). No difference in patient satisfaction was observed between groups, and provider satisfaction was mixed. Conclusion: This study provides no strong evidence to support the utility of this decision-support tool, but it demonstrates the value of rigorous evaluation of decision-support information technology."
To examine the effects of a decision support system on "quality, resource consumption and patient and provider satisfaction."
Tools Used
Other Information
The trial was conducted at two military treatment facilities: Ireland Army Community Hospital and Clinics, Fort Knox, Kentucky, and Mayport Branch Health Clinic, Mayport, Florida.
Type of Health IT
Decision support system
Type of Health IT Functions
The DSS "uses structured questions based on the patient's chief complaint to elicit information from the patient and the provider. That information is linked to a proprietary database of medical knowledge that generates suggestions for appropriate patient care strategies, including options relevant to the patient's diagnosis and treatment.... [The decision support system is] available for a wide range of preventive health care needs and patient complaints, including common conditions. Patients randomized to use [the DSS] completed the one appropriate for their specific complaint or, when no condition-specific [DSS component] was appropriate, a generic History and Screening [component], replicating the Military Health System's intended use for [the DSS]. Patients entered their medical histories into the [DSS] tool with the assistance of a coordinator who was not associated with the study; 30 minutes was allocated for that process. Providers treating [patients in the DSS group] could enter additional information before reviewing [DSS] outputs outlining diagnosis or treatment options."
Workflow-Related Findings
"There was no significant difference in the proportion of health care opportunities fulfilled [by indicated treatment] in the [DSS] and usual-care groups (33.9% vs 30.7%; P=.12).The hierarchical multivariable analysis (adjusting for age, sex, military status, visit type, opportunity type, and site) also found no significant effect of assignment to the [DSS] group on the probability of health care opportunity fulfillment (odds ratio for opportunities being fulfilled in the [DSS] group compared with the usual-care group: 1.14; 95% confidence interval, 0.95-1.38; P=.16)." Patients in the DSS were more likely to receive alcohol and smoking screening and hypertension treatment, however.
"In the analysis by opportunity subgroup (screening/prevention or acute/chronic), there were slightly more screening/prevention opportunities fulfilled in the [DSS] group vs the usual-care group (34.8% vs 30.4%; P=.03), with dietary and exercise counseling being primarily responsible for the difference....In contrast to screening/prevention opportunities, there were slightly fewer acute/chronic opportunities fulfilled in the [DSS] group vs the usual-care group (27.7% vs 32.6%), although this difference was not significant."
"[DSS] group patients used more laboratory and pharmacy resources than usual-care group patients."
Physician satisfaction data showed that "[t]he strongest level of perceived satisfaction related to information quality: 75% agreed or strongly agreed that [the DSS] provides high-quality information. The strongest level of dissatisfaction related to time use, with 83% disagreeing or strongly disagreeing that [DSS] use involves acceptable amounts of time. More than half of the providers also disagreed with the statements of benefits for medical decision making (70%), improved provider-patient interactions (61%), and overall benefits to patients (70%)."
Study Design
Randomized controlled trial (RCT)
Study Participants
"Patients aged 18 years and older were eligible [to participate in the study] if they had scheduled appointments, could speak and read English, had not participated in [DSS] sessions, were not scheduled for obstetric care, and had no emergency medical conditions."