Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium.
Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
Implement Sci. 2020 Nov 4;15(1):100. doi: 10.1186/s13012-020-01059-y.
Inappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care.
This study was a pragmatic, cluster randomized, open-label, controlled clinical trial.
Two hundred eighty general practitioners (GPs) from 72 primary care practices in Belgium.
Patients aged ≥ 18 years with a laboratory test order for at least one of 17 indications: cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication.
The CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician.
The primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume, and cascade activities.
CDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16-0.26, p < 0.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37-10.93, p = 0.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease-0.05% increase) in possible diagnostic error.
A CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error.
ClinicalTrials.gov Identifier: NCT02950142 , registered on October 25, 2016.
不适当的实验室检验医嘱会给医疗保健带来沉重负担。临床决策支持系统（CDSS）已被认为是改善实验室检验医嘱行为的有前途的工具。本研究的目的是评估将临床决策支持服务整合到计算机化医嘱录入系统（CPOE）中对医嘱的适宜性和数量以及初级保健中诊断错误的影响。
本研究为一项实用的、基于群组的、随机、开放标签、对照临床试验。
比利时 72 个基层医疗实践中的 280 名全科医生（GP）。
年龄≥18 岁的患者，实验室检验医嘱至少为以下 17 种适应证之一：心血管疾病管理、高血压、体检、慢性肾脏病（CKD）、甲状腺疾病、2 型糖尿病、疲劳、贫血、肝病、痛风、疑似急性冠状动脉综合征（ACS）、疑似肺栓塞、类风湿关节炎、性传播感染（STI）、急性腹泻、慢性腹泻和药物随访。
CDSS 以基于证据的医嘱集的形式整合到计算机化医嘱录入系统（CPOE）中，根据全科医生提供的适应证，建议进行适当的检验。
ELMO 研究的主要结果是总医嘱检验数量中适当检验的比例和不适宜的未请求检验的比例。ELMO 研究的次要结果包括诊断错误、检验量和级联活动。
对于纳入研究的所有检验，CDSS 将适当检验的比例提高了 0.21（95%CI 0.16-0.26，p<0.0001）。CDSS 组的 GP 每小组医嘱检验数量减少了 7 项（7.15（95%CI 3.37-10.93，p=0.0002））。CDSS 并未增加诊断错误。比例的绝对差异为可能的诊断错误减少 0.66%（95%CI 1.4%减少-0.05%增加）。
CPOE 中以医嘱集形式的 CDSS 提高了实验室检验医嘱的适宜性，并减少了检验量，而不会增加诊断错误。
ClinicalTrials.gov 标识符：NCT02950142，于 2016 年 10 月 25 日注册。
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