van Wyk Jacobus T, van Wijk Marc A M, Sturkenboom Miriam C J M, Mosseveld Mees, Moorman Peter W, van der Lei Johan
Department of Medical Informatics, ErasmusMC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Circulation. 2008 Jan 22;117(3):371-8. doi: 10.1161/CIRCULATIONAHA.107.697201. Epub 2008 Jan 2.
Indirect evidence shows that alerting users with clinical decision support systems seems to change behavior more than requiring users to actively initiate the system. However, randomized trials comparing these methods in a clinical setting are lacking. We studied the effect of both alerting and on-demand decision support with respect to screening and treatment of dyslipidemia based on the guidelines of the Dutch College of General Practitioners.
In a clustered randomized trial design, 38 Dutch general practices (77 physicians) and 87,886 of their patients (39,433 men 18 to 70 years of age and 48,453 women 18 to 75 years of age) who used the ELIAS electronic health record participated. Each practice was assigned to receive alerts, on-demand support, or no intervention. We measured the percentage of patients screened and treated after 12 months of follow-up. In the alerting group, 65% of the patients requiring screening were screened (relative risk versus control=1.76; 95% confidence interval, 1.41 to 2.20) compared with 35% of patients in the on-demand group (relative risk versus control=1.28; 95% confidence interval, 0.98 to 1.68) and 25% of patients in the control group. In the alerting group, 66% of patients requiring treatment were treated (relative risk versus control=1.40; 95% confidence interval, 1.15 to 1.70) compared with 40% of patients (relative risk versus control=1.19; 95% confidence interval, 0.94 to 1.50) in the on-demand group and 36% of patients in the control group.
The alerting version of the clinical decision support systems significantly improved screening and treatment performance for dyslipidemia by general practitioners.
间接证据表明，使用临床决策支持系统提醒用户似乎比要求用户主动启动系统更能改变行为。然而，缺乏在临床环境中比较这些方法的随机试验。我们根据荷兰全科医生学院的指南，研究了提醒和按需决策支持对血脂异常筛查和治疗的影响。
在一项整群随机试验设计中，38家荷兰全科诊所（77名医生）及其87886名使用ELIAS电子健康记录的患者（39433名18至70岁男性和48453名18至75岁女性）参与其中。每家诊所被分配接受提醒、按需支持或不干预。我们测量了随访12个月后接受筛查和治疗的患者百分比。在提醒组中，需要筛查的患者中有65%接受了筛查（与对照组相比的相对风险=1.76；95%置信区间，1.41至2.20），而按需组为35%（与对照组相比的相对风险=1.28；95%置信区间，0.98至1.68），对照组为25%。在提醒组中，需要治疗的患者中有66%接受了治疗（与对照组相比的相对风险=1.40；95%置信区间，1.15至1.70），而按需组为40%（与对照组相比的相对风险=1.19；95%置信区间，0.94至1.50），对照组为36%。
临床决策支持系统的提醒版本显著提高了全科医生对血脂异常的筛查和治疗效果。
