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Effects of documentation-based decision support on chronic disease management
Jeffrey L Schnipper1, Jeffrey A Linder, Matvey B Palchuk
1Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA. jschnipper@partners.org
A new clinical decision support system (CDSS) modestly improved care for coronary artery disease (CAD) and diabetes mellitus (DM) patients when used. Future efforts should focus on integration and promoting use of these documentation-based tools.
Area of Science:
- Cardiology
- Endocrinology
- Health Informatics
Background:
- Deficiencies in care for patients with coronary artery disease (CAD) and diabetes mellitus (DM) are common.
- Clinical decision support systems (CDSS) aim to improve care quality by providing timely information and prompts.
- Documentation-based CDSS may help address specific care gaps in chronic disease management.
Purpose of the Study:
- To evaluate the effectiveness of a novel documentation-based CDSS, the CAD/DM Smart Form, in improving care for patients with CAD and DM.
- To assess the impact of the CDSS on addressing care deficiencies within 30 days of a patient visit.
Main Methods:
- A controlled trial randomized primary care physicians (PCPs) to either usual care or the CAD/DM Smart Form intervention.
- The study involved 10 ambulatory practices over a 9-month period.
- The primary outcome measured was the proportion of care deficiencies addressed within 30 days post-visit.
Main Results:
- The CAD/DM Smart Form was utilized for 5.6% of eligible patients.
- Intention-to-treat analysis showed a statistically significant improvement in addressed deficiencies for intervention PCPs (11.4% vs. 10.1%, P = .02).
- On-treatment analysis revealed a greater improvement when the Smart Form was used (17.0% vs. 10.6%, P < .001), particularly in smoking status documentation and antiplatelet prescription.
Conclusions:
- The overall utilization of the CAD/DM Smart Form was low, leading to modest improvements in patient care management.
- Despite low usage, the documentation-based CDSS demonstrated potential when implemented.
- Future research should concentrate on refining CDSS tools, integrating them into electronic health records, and promoting their adoption through practice-level changes.
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