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

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.