Appl Clin Inform - User centered clinical decision support tools: adoption across clinician training level.

Tópicos

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Resumo

CKGROUND: Dissemination and adoption of clinical decision support (CDS) tools is a major initiative of the Affordable Care Act's Meaningful Use program. Adoption of CDS tools is multipronged with personal, organizational, and clinical settings factoring into the successful utilization rates. Specifically, the diffusion of innovation theory implies that 'early adopters' are more inclined to use CDS tools and younger physicians tend to be ranked in this category.OBJECTIVE: This study examined the differences in adoption of CDS tools across providers' training level.PARTICIPANTS: From November 2010 to 2011, 168 residents and attendings from an academic medical institution were enrolled into a randomized controlled trial.INTERVENTION: The intervention arm had access to the CDS tool through the electronic health record (EHR) system during strep and pneumonia patient visits.MAIN MEASURES: The EHR system recorded details on how intervention arm interacted with the CDS tool including acceptance of the initial CDS alert, completion of risk-score calculators and the signing of medication order sets. Using the EHR data, the study performed bivariate tests and general estimating equation (GEE) modeling to examine the differences in adoption of the CDS tool across residents and attendings.KEY RESULTS: The completion rates of the CDS calculator and medication order sets were higher amongst first year residents compared to all other training levels. Attendings were the less likely to accept the initial step of the CDS tool (29.3%) or complete the medication order sets (22.4%) that guided their prescription decisions, resulting in attendings ordering more antibiotics (37.1%) during an CDS encounter compared to residents.CONCLUSION: There is variation in adoption of CDS tools across training levels. Attendings tended to accept the tool less but ordered more medications. CDS tools should be tailored to clinicians' training levels.

Resumo Limpo

ckground dissemin adopt clinic decis support cds tool major initi afford care act meaning use program adopt cds tool multiprong person organiz clinic set factor success util rate specif diffus innov theori impli earli adopt inclin use cds tool younger physician tend rank categoryobject studi examin differ adopt cds tool across provid train levelparticip novemb resid attend academ medic institut enrol random control trialintervent intervent arm access cds tool electron health record ehr system strep pneumonia patient visitsmain measur ehr system record detail intervent arm interact cds tool includ accept initi cds alert complet riskscor calcul sign medic order set use ehr data studi perform bivari test general estim equat gee model examin differ adopt cds tool across resid attendingskey result complet rate cds calcul medic order set higher amongst first year resid compar train level attend less like accept initi step cds tool complet medic order set guid prescript decis result attend order antibiot cds encount compar residentsconclus variat adopt cds tool across train level attend tend accept tool less order medic cds tool tailor clinician train level

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