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Am J Manag Care. 2018 Aug;24(8):361-366.
To determine whether utilization of clinical decision support (CDS) is correlated with improved patient clinical and financial outcomes.
Observational study of 26,424 patient encounters. In the treatment group, the provider adhered to all CDS recommendations. In the control group, the provider did not adhere to CDS recommendations.
An observational study of provider adherence to a CDS system was conducted using inpatient encounters spanning 3 years. Data comprised alert status (adherence), provider type (resident, attending), patient demographics, clinical outcomes, Medicare status, and diagnosis information. We assessed the associations between alert adherence and 4 outcome measures: encounter length of stay, odds of 30-day readmission, odds of complications of care, and total direct costs. The associations between alert adherence and the outcome measures were estimated using 4 generalized linear models that adjusted for potential confounders, such as illness severity and case complexity.
The total encounter cost increased 7.3% (95% CI, 3.5%-11%) for nonadherent encounters versus adherent encounters. We found a 6.2% (95% CI, 3.0%-9.4%) increase in length of stay for nonadherent versus adherent encounters. The odds ratio for readmission within 30 days increased by 1.14 (95% CI, 0.998-1.31) for nonadherent versus adherent encounters. The odds ratio for complications increased by 1.29 (95% CI, 1.04-1.61) for nonadherent versus adherent encounters.
Consistent improvements in measured outcomes were seen in the treatment group versus the control group. We recommend that provider organizations consider the introduction of real-time CDS to support adherence to evidence-based guidelines, but because we cannot determine the cause of the associations between CDS interventions and improved clinical and financial outcomes, further study is required.
确定临床决策支持（CDS）的使用是否与改善患者的临床和财务结果相关。
对 26424 例患者就诊的观察性研究。在治疗组中，医生遵循了所有 CDS 建议。在对照组中，医生未遵循 CDS 建议。
对 3 年内的住院患者就诊进行了一项关于医生对 CDS 系统的遵守情况的观察性研究。数据包括警报状态（遵守）、医生类型（住院医生、主治医生）、患者人口统计学信息、临床结果、医疗保险状态和诊断信息。我们评估了警报遵守情况与 4 种结果指标之间的关联：就诊住院时间、30 天内再入院的几率、护理并发症的几率和直接总成本。使用 4 种广义线性模型来估计警报遵守情况与结果指标之间的关联，这些模型调整了潜在混杂因素，如疾病严重程度和病例复杂性。
与遵守的就诊相比，不遵守的就诊的总就诊费用增加了 7.3%（95%CI，3.5%-11%）。我们发现，不遵守的就诊比遵守的就诊的住院时间延长了 6.2%（95%CI，3.0%-9.4%）。30 天内再入院的几率非遵守就诊比遵守就诊增加了 1.14（95%CI，0.998-1.31）。非遵守就诊的并发症几率比遵守就诊增加了 1.29（95%CI，1.04-1.61）。
在治疗组与对照组中，观察到测量结果的一致改善。我们建议医疗机构考虑引入实时 CDS 以支持对循证指南的遵守，但由于我们无法确定 CDS 干预措施与改善临床和财务结果之间的关联的原因，因此需要进一步研究。
