Leveraging electronic medical records to evaluate a computerized decision support system for staphylococcus...

Area of Science:

• Infectious Diseases
• Health Informatics
• Clinical Decision Support

Background:

• Infectious disease specialists (IDS) improve outcomes for Staphylococcus bacteremia patients.
• Immediate access to IDS is not always feasible.
• Standard of care (SOC) may be enhanced by technology.

Purpose of the Study:

• To investigate if a care-integrated computerized decision support system (CDSS) can safely enhance SOC for Staphylococcus bacteremia.
• To assess the noninferiority of CDSS compared to SOC regarding patient mortality.

Main Methods:

• Multicenter, noninferiority, interventional, stepped-wedge cluster randomized controlled trial.
• Utilized data integration centers and electronic medical records across five university hospitals.
• Analyzed 5056 patients with Staphylococcus aureus (SAB) and coagulase-negative staphylococci (CoNS) bacteremia.

Main Results:

• CDSS was noninferior to SOC for hospital mortality in all patients.
• Noninferiority was not observed for 90-day mortality/relapse in SAB patients.
• No significant differences in vancomycin usage were found for CoNS patients.

Conclusions:

• CDSS shows potential for improving care in Staphylococcus bacteremia but requires further evaluation for specific outcomes.
• Physician-reported usability of the CDSS was favorable despite low reported usage.
• The study highlights the need for robust systems to support infectious disease management.