Appl Clin Inform. 2013 Mar 27;4(1):144-52. doi: 10.4338/ACI-2012-12-RA-0055. Print 2013.
In a previous study, we reported on a successful clinical decision support (CDS) intervention designed to improve electronic problem list accuracy, but did not study variability of provider response to the intervention or provider attitudes towards it. The alert system accurately predicted missing problem list items based on health data captured in a patient's electronic medical record.
To assess provider attitudes towards a rule-based CDS alert system as well as heterogeneity of acceptance rates across providers.
We conducted a by-provider analysis of alert logs from the previous study. In addition, we assessed provider opinions of the intervention via an email survey of providers who received the alerts (n = 140).
Although the alert acceptance rate was 38.1%, individual provider acceptance rates varied widely, with an interquartile range (IQR) of 14.8%-54.4%, and many outliers accepting none or nearly all of the alerts they received. No demographic variables, including degree, gender, age, assigned clinic, medical school or graduation year predicted acceptance rates. Providers' self-reported acceptance rate and perceived alert frequency were only moderately correlated with actual acceptance rates and alert frequency.
Acceptance of this CDS intervention among providers was highly variable but this heterogeneity is not explained by measured demographic factors, suggesting that alert acceptance is a complex and individual phenomenon. Furthermore, providers' self-reports of their use of the CDS alerting system correlated only modestly with logged usage.
在之前的一项研究中，我们报告了一项成功的临床决策支持（CDS）干预措施，旨在提高电子问题清单的准确性，但没有研究提供者对干预措施的反应的可变性或对其的态度。该警报系统可根据患者电子病历中捕获的健康数据准确预测缺失的问题清单项目。
评估提供者对基于规则的 CDS 警报系统的态度以及提供者对其接受程度的异质性。
我们对之前研究中的警报日志进行了按提供者的分析。此外，我们通过向收到警报的提供者（n=140）发送电子邮件调查来评估他们对干预措施的看法。
尽管警报接受率为 38.1%，但个别提供者的接受率差异很大，四分位间距（IQR）为 14.8%-54.4%，许多异常值接受的警报数量为零或几乎全部接受。没有任何人口统计学变量，包括学位、性别、年龄、分配的诊所、医学院或毕业年份，能够预测接受率。提供者自我报告的接受率和感知的警报频率与实际接受率和警报频率只有中度相关。
提供者对这种 CDS 干预措施的接受程度差异很大，但这种异质性不能用测量的人口统计学因素来解释，这表明警报的接受是一个复杂的个人现象。此外，提供者对 CDS 警报系统的自我报告的使用情况与记录的使用情况仅呈适度相关。
