De-Implementation Strategies in Colorectal Cancer: Development, Implementation and Results of a Service-Oriented CDSS

Area of Science:

• Clinical Informatics
• Geriatric Medicine
• Health Services Research

Background:

• Unnecessary colonoscopies in older adults represent a significant healthcare cost and potential patient harm.
• Evidence-based guidelines recommend against routine colonoscopies for patients aged 75 and older without specific indications.
• Clinical decision support systems (CDSS) offer a potential avenue to align practice with evidence.

Purpose of the Study:

• To develop and implement an electronic health record (EHR)-integrated alert system.
• To de-implement potentially unnecessary colonoscopies in patients aged 75 years and older.
• To evaluate the preliminary results of the CDSS alert system.

Main Methods:

• An alert was integrated into the EHR system.
• The CDSS generated alerts for physicians considering colonoscopies for patients 75+.
• Data were collected on alert generation, physician overrides, and acceptance rates.

Main Results:

• From August 20 to November 29, 2024, 567 alerts were generated.
• Alerts were issued to 244 physicians for 499 patients.
• Physicians overrode 91.8% of alerts and accepted 7%.

Conclusions:

• The initial implementation of the CDSS alert showed a low acceptance rate.
• Further refinement of alert specificity is needed to improve adherence.
• De-implementation strategies using CDSS hold promise for promoting evidence-based care in older adults.