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Electronic Health Record Clinical Decision Support Tool Improves Ambulatory Reflux Testing Practices.

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  • 1Division of Gastroenterology, Duke University, Durham, North Carolina, USA.

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Clinical decision support (CDS) tools improved reflux testing practices. The study found a decrease in unnecessary testing and an increase in appropriate diagnostic utility and clinical management changes.

Keywords:
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Area of Science:

  • Gastroenterology
  • Clinical Informatics
  • Health Services Research

Background:

  • Gastroesophageal reflux disease (GERD) diagnosis requires careful consideration.
  • Unnecessary reflux testing without a confirmed GERD diagnosis is common and reduces diagnostic utility.
  • Best practice guidelines recommend against testing without a prior diagnosis.

Purpose of the Study:

  • To evaluate the effectiveness of a novel clinical decision support (CDS) tool in improving reflux testing ordering practices.
  • To assess the impact of CDS on diagnostic utility and clinical management changes.

Main Methods:

  • Quality improvement methodologies were employed.
  • A novel CDS tool was developed and implemented.
  • The impact of the CDS tool on testing rates, best practice concordance, and clinical management was analyzed.

Main Results:

  • Reflux testing rates on acid suppression significantly decreased post-CDS implementation (30.9% to 8.4%; p<0.01).
  • Concordance with best practice recommendations substantially increased (16.4% to 60.0%; p<0.001).
  • Meaningful clinical management changes rose significantly (23.1% to 60.0%; p=0.01).

Conclusions:

  • Clinical decision support for reflux testing enhances appropriate ordering practices.
  • CDS implementation leads to improved diagnostic utility and more effective clinical management decisions.