Evaluating alert fatigue over time to EHR-based clinical trial alerts: findings from a randomized controlled study

Area of Science:

• Clinical Research Informatics
• Health Services Research

Background:

• Participant recruitment is a critical challenge in clinical research.
• Electronic health record (EHR)-based, point-of-care clinical trial alerts (CTAs) show promise for improving recruitment.
• Further understanding of CTA user response patterns is needed.

Purpose of the Study:

• To investigate whether repeated exposure to CTAs leads to declining user responsiveness.
• To quantify the extent of this decline, if present.
• To inform future CTA deployment strategies.

Main Methods:

• A 36-week study involving 178 physician users receiving CTAs for an ongoing clinical trial.
• Systematic documentation of response rates and referral rates per physician.
• Poisson regression analysis, adjusting for the number of alerts received.

Main Results:

• A significant downward trend in CTA response rates was observed over time (2.7% decrease per period, p<0.0001).
• Response rates remained between 30%-40% even after 36 weeks.
• Significant differences in response rates were noted between community-based and university-based physicians (p=0.0489).

Conclusions:

• CTA responsiveness gradually declines with prolonged exposure but remains reasonably high.
• Differences in responsiveness exist between community and university physicians.
• Findings contribute to understanding EHR-based alert fatigue and inform future CTA optimization.