Kuilboer MM et al. 2006 "Computed critiquing integrated into daily clinical practice affects physicians' behavior - a randomized clinical trial with AsthmaCritic."
Reference
Kuilboer MM, van Wijk MAM, Mosseveld M, et al. Computed critiquing integrated into daily clinical practice affects physicians' behavior - a randomized clinical trial with AsthmaCritic. Methods Inf Med 2006;45(4):447-454.
Abstract
"Objective: We developed...a non-inquisitive critiquing system integrated with the general practitioners' electronic medical records. The system is based on the guidelines for asthma and chronic obstructive pulmonary disease (COPD) as issued by the Dutch College of General Practitioners. This paper assesses the effect of [this system] on monitoring and treatment of asthma and COPD by Dutch general practitioners in daily practice.
Methods: A randomized clinical trial in 32 practices (40 Dutch general practitioners) using electronic patient records. An intervention group was given the use of [the system], a control group continued working in the usual manner. Both groups had the disposal of the asthma and COPD guidelines routinely distributed by the Dutch College of General Practitioners. We measured the average number of contacts, FEV1 (forced expiratory volume), and peak-flow measurements per asthma/COPD patient per practice; and, the average number of antihistamine, cromoglycate, deptropine, and oral bronchodilator prescriptions per asthma/COPD patient per practice.
Results: The number of contacts increased in the age group of 12-39 years. The number of FEV1, peak-flow measurements, and the ratio of coded measurements increased, whereas the number of cromoglycate prescriptions decreased in the age group of 12-39 years. Conclusions: Our study shows that the guideline-based critiquing system ... changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits."
Methods: A randomized clinical trial in 32 practices (40 Dutch general practitioners) using electronic patient records. An intervention group was given the use of [the system], a control group continued working in the usual manner. Both groups had the disposal of the asthma and COPD guidelines routinely distributed by the Dutch College of General Practitioners. We measured the average number of contacts, FEV1 (forced expiratory volume), and peak-flow measurements per asthma/COPD patient per practice; and, the average number of antihistamine, cromoglycate, deptropine, and oral bronchodilator prescriptions per asthma/COPD patient per practice.
Results: The number of contacts increased in the age group of 12-39 years. The number of FEV1, peak-flow measurements, and the ratio of coded measurements increased, whereas the number of cromoglycate prescriptions decreased in the age group of 12-39 years. Conclusions: Our study shows that the guideline-based critiquing system ... changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits."
Objective
To "assess the effect of [a decision support system] on monitoring and treatment of asthma and COPD by Dutch general practitioners in daily practice."
Type Clinic
Primary care
Size
Small and/or medium
Geography
Urban
Other Information
The study was located in Delft, the Netherlands.
Type of Health IT
Decision support system
Type of Health IT Functions
The system uses information entered by the patient to evaluate whether a patient has asthma or COPD. Then it reviews the physicians' treatments and provides feedback in the form of comments on treatment, including recommendations for changes in treatment, and calculations on patient measurements (such as peak flow values). To provide context for the measurements the system also provides expected values for the patient based on gender, age, and height.
Context or other IT in place
Electronic medical records (EMR)
Workflow-Related Findings
The DSS took an average of 31.7 seconds to analyze the patient record. In 22 percent of cases, the physician waited for the results of the DSS.
Physicians read comments provided by the DSS in 32 percent of cases. The fact that system "generate[s] feedback even if the contact does not cover asthma- or COPD-related issues" may be a cause of the low percentage of comments that are read.
They spent an average of 9 seconds reading the comments.
Physicians entered more of the recorded patient data in a structured format of "coded measurements," rather than free-text. This change may be due to the fact that "availability of structured data is vital for [the system] to produce patient-specific feedback."
The physicians in the intervention group saw patients more frequently and measured the pulmonary function of young patients more often than those in the control group.
There was a "larger decrease in the average number of cromoglycate prescriptions in the [intervention] group" for patients aged 12-39 years, as recommended in the revised guidelines.
Study Design
Randomized controlled trial (RCT)
Study Participants
A total of 40 general practitioners working in 32 clinics in the Netherlands participated in the study. The 20 practicioners assigned to the intervention group had 10,863 patient visits in which the system was triggered.