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Provider response to computer-based care suggestions for chronic heart failure
Brian Keeffe1, Usha Subramanian, William M Tierney
1Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington, USA.
Medical Care
|April 20, 2005
Summary
Primary care providers agreed with less than half of computer-generated chronic heart failure (CHF) care suggestions. Disagreements stemmed from perceived inapplicability or patient intolerance, not guideline issues.
Area of Science:
- Clinical Informatics
- Cardiology
- Primary Care Medicine
Background:
- Computer-generated clinical decision support systems aim to improve chronic heart failure (CHF) management.
- Provider acceptance is crucial for the successful implementation of these systems.
Purpose of the Study:
- To evaluate primary care providers' responses to computer-generated recommendations for CHF care.
- To identify reasons for provider agreement or disagreement with these recommendations.
Main Methods:
- Analysis of primary care provider responses to computer-generated CHF care suggestions from a randomized trial.
- Providers used handwritten comments and a numerical scale to indicate agreement with suggestions.
- Data collected from one center of a randomized trial involving two VA Medical Centers.
Main Results:
- Providers responded to 62% of 1246 delivered care suggestions.
- Agreement was 41%, with major disagreements at 12% and minor disagreements at 22%.
- Primary reasons for disagreement included perceived incorrectness, lack of necessity, or anticipated patient intolerance.
Conclusions:
- Provider agreement with computer-generated CHF guidelines was below 50%.
- Key reasons for disagreement were suggestions deemed inapplicable or likely to be poorly tolerated by patients.
- External barriers and guideline-specific issues were infrequent reasons for non-adherence.