Understanding why clinicians answer or ignore clinical decision support prompts

Area of Science:

• Clinical Informatics
• Human-Computer Interaction
• Health Services Research

Background:

• Understanding factors influencing clinician engagement with computer decision support systems (CDSS) is crucial for optimizing their effectiveness.
• Previous research has not extensively explored why specific prompts within a CDSS are consistently addressed while others are overlooked.

Purpose of the Study:

• To investigate the reasons behind clinicians' differential responses to prompts and reminders presented by a CDSS.
• To identify key factors that predict whether a clinician will act on a CDSS alert.

Main Methods:

• Utilized data from the Child Health Improvement through Computer Automation (CHICA) system, a developed CDSS.
• The primary metric for analysis was the clinician's response to a given prompt.

Main Results:

• Clinician and clinic-level variations in prompt response rates were observed.
• Prompts related to younger patients and more severe conditions showed higher response rates.
• Prompt placement was a significant predictor, with prompts at the top of the display being addressed more frequently than those at the bottom, even after accounting for other variables.

Conclusions:

• Several factors influence physician adherence to clinical decision support prompts, including patient age, issue severity, and prompt positioning.
• These findings can inform the design of more effective interventions and enhance the success of future clinical decision support systems.