Children's Health Services Research, Indianapolis, Ind; Regenstrief Institute Inc, Indianapolis, Ind.
Children's Health Services Research, Indianapolis, Ind; Regenstrief Institute Inc, Indianapolis, Ind.
Acad Pediatr. 2015 Mar-Apr;15(2):158-64. doi: 10.1016/j.acap.2014.10.009. Epub 2015 Jan 22.
Physicians typically respond to roughly half of the clinical decision support prompts they receive. This study was designed to test the hypothesis that selectively highlighting prompts in yellow would improve physicians' responsiveness.
We conducted a randomized controlled trial using the Child Health Improvement Through Computer Automation clinical decision support system in 4 urban primary care pediatric clinics. Half of a set of electronic prompts of interest was highlighted in yellow when presented to physicians in 2 clinics. The other half of the prompts was highlighted when presented to physicians in the other 2 clinics. Analyses compared physician responsiveness to the 2 randomized sets of prompts: highlighted versus not highlighted. Additionally, several prompts deemed high priority were highlighted during the entire study period in all clinics. Physician response rates to the high-priority highlighted prompts were compared to response rates for those prompts from the year before the study period, when they were not highlighted.
Physicians did not respond to prompts that were highlighted at higher rates than prompts that were not highlighted (62% and 61%, respectively; odds ratio 1.056, P = .259, NS). Similarly, physicians were no more likely to respond to high-priority prompts that were highlighted compared to the year before, when the prompts were not highlighted (59% and 59%, respectively, χ(2) = 0.067, P = .796, NS).
Highlighting reminder prompts did not increase physicians' responsiveness. We provide possible explanations why highlighting did not improve responsiveness and offer alternative strategies to increasing physician responsiveness to prompts.
医生通常对他们收到的大约一半的临床决策支持提示做出回应。本研究旨在验证以下假设，即选择性地将提示标记为黄色会提高医生的响应能力。
我们使用儿童健康改善计算机自动化临床决策支持系统（Child Health Improvement Through Computer Automation，CHICA）在 4 家城市初级保健儿科诊所进行了一项随机对照试验。在 2 家诊所中，当向医生展示一组感兴趣的电子提示时，其中一半以黄色突出显示。在另外 2 家诊所中向医生展示时，另一半以黄色突出显示。分析比较了医生对 2 组随机提示的响应：突出显示与不突出显示。此外，在整个研究期间，所有诊所都突出显示了一些被认为是高优先级的提示。将高优先级突出显示的提示的医生响应率与研究前一年未突出显示这些提示的响应率进行比较。
与未突出显示的提示相比，突出显示的提示的医生响应率并没有更高（分别为 62%和 61%；优势比 1.056，P=.259，NS）。同样，与研究前一年未突出显示时相比，突出显示的高优先级提示的医生响应率也没有更高（分别为 59%和 59%，χ²=0.067，P=.796，NS）。
突出显示提醒提示并没有提高医生的响应能力。我们提供了一些可能的解释，说明为什么突出显示没有提高响应能力，并提供了其他策略来提高医生对提示的响应能力。
