Appl Clin Inform - Provider use of and attitudes towards an active clinical alert: a case study in decision support.

Tópicos

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Resumo

CKGROUND: In a previous study, we reported on a successful clinical decision support (CDS) intervention designed to improve electronic problem list accuracy, but did not study variability of provider response to the intervention or provider attitudes towards it. The alert system accurately predicted missing problem list items based on health data captured in a patient's electronic medical record.OBJECTIVE: To assess provider attitudes towards a rule-based CDS alert system as well as heterogeneity of acceptance rates across providers.METHODS: We conducted a by-provider analysis of alert logs from the previous study. In addition, we assessed provider opinions of the intervention via an email survey of providers who received the alerts (n = 140).RESULTS: Although the alert acceptance rate was 38.1%, individual provider acceptance rates varied widely, with an interquartile range (IQR) of 14.8%-54.4%, and many outliers accepting none or nearly all of the alerts they received. No demographic variables, including degree, gender, age, assigned clinic, medical school or graduation year predicted acceptance rates. Providers' self-reported acceptance rate and perceived alert frequency were only moderately correlated with actual acceptance rates and alert frequency.CONCLUSIONS: Acceptance of this CDS intervention among providers was highly variable but this heterogeneity is not explained by measured demographic factors, suggesting that alert acceptance is a complex and individual phenomenon. Furthermore, providers' self-reports of their use of the CDS alerting system correlated only modestly with logged usage.

Resumo Limpo

ckground previous studi report success clinic decis support cds intervent design improv electron problem list accuraci studi variabl provid respons intervent provid attitud toward alert system accur predict miss problem list item base health data captur patient electron medic recordobject assess provid attitud toward rulebas cds alert system well heterogen accept rate across providersmethod conduct byprovid analysi alert log previous studi addit assess provid opinion intervent via email survey provid receiv alert n result although alert accept rate individu provid accept rate vari wide interquartil rang iqr mani outlier accept none near alert receiv demograph variabl includ degre gender age assign clinic medic school graduat year predict accept rate provid selfreport accept rate perceiv alert frequenc moder correl actual accept rate alert frequencyconclus accept cds intervent among provid high variabl heterogen explain measur demograph factor suggest alert accept complex individu phenomenon furthermor provid selfreport use cds alert system correl modest log usag

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