Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
Department of Biomedical Informatics, Stanford University School of Medicine, Stanford, California, USA.
J Am Med Inform Assoc. 2022 Oct 7;29(11):1941-1948. doi: 10.1093/jamia/ocac139.
To assess the efficacy of interruptive electronic alerts in improving adherence to the American Board of Internal Medicine's Choosing Wisely recommendations to reduce unnecessary laboratory testing.
We administered 5 cluster randomized controlled trials simultaneously, using electronic medical record alerts regarding prostate-specific antigen (PSA) testing, acute sinusitis treatment, vitamin D testing, carotid artery ultrasound screening, and human papillomavirus testing. For each alert, we assigned 5 outpatient clinics to an interruptive alert and 5 were observed as a control. Primary and secondary outcomes were the number of postalert orders per 100 patients at each clinic and number of triggered alerts divided by orders, respectively. Post hoc analysis evaluated whether physicians experiencing interruptive alerts reduced their alert-triggering behaviors.
Median postalert orders per 100 patients did not differ significantly between treatment and control groups; absolute median differences ranging from 0.04 to 0.40 for PSA testing. Median alerts per 100 orders did not differ significantly between treatment and control groups; absolute median differences ranged from 0.004 to 0.03. In post hoc analysis, providers receiving alerts regarding PSA testing in men were significantly less likely to trigger additional PSA alerts than those in the control sites (Incidence Rate Ratio 0.12, 95% CI [0.03-0.52]).
Interruptive point-of-care alerts did not yield detectable changes in the overall rate of undesired orders or the order-to-alert ratio between active and silent sites. Complementary behavioral or educational interventions are likely needed to improve efforts to curb medical overuse.
Implementation of interruptive alerts at the time of ordering was not associated with improved adherence to 5 Choosing Wisely guidelines.
NCT02709772.
评估中断式电子提醒在提高对美国内科医师学会选择明智建议的遵从性，以减少不必要的实验室检测方面的效果。
我们同时进行了 5 项群组随机对照试验，使用电子病历提醒有关前列腺特异性抗原（PSA）检测、急性鼻窦炎治疗、维生素 D 检测、颈动脉超声筛查和人乳头瘤病毒检测。对于每个提醒，我们将 5 个门诊诊所分配到中断式提醒组，另外 5 个作为对照组进行观察。主要和次要结局指标分别为每个诊所每 100 名患者的后续提醒订单数和触发的提醒数除以订单数。事后分析评估了经历中断式提醒的医生是否减少了他们的触发提醒行为。
治疗组和对照组每 100 名患者的后续订单中位数没有显著差异；PSA 检测的绝对中位数差异范围为 0.04 至 0.40。治疗组和对照组的每 100 个订单的提醒中位数没有显著差异；绝对中位数差异范围为 0.004 至 0.03。事后分析显示，接受男性 PSA 检测提醒的医生触发额外 PSA 提醒的可能性明显低于对照组（发生率比 0.12，95%CI [0.03-0.52]）。
在活跃和静默站点之间，中断式即时提醒并没有导致不必要订单的总体率或订单与提醒的比例发生可检测的变化。可能需要补充行为或教育干预措施来提高遏制医疗过度使用的努力。
在下达医嘱时实施中断式提醒与 5 项选择明智指南的遵从性改善无关。
NCT02709772。
