Medical Informatics, Kaiser Permanente Southern California, San Diego, CA, USA.
Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
J Am Med Inform Assoc. 2022 Dec 13;30(1):64-72. doi: 10.1093/jamia/ocac191.
Clinical decision support (CDS) alerts may improve health care quality but "alert fatigue" can reduce provider responsiveness. We analyzed how the introduction of competing alerts affected provider adherence to a single depression screening alert.
We analyzed the audit data from all occurrences of a CDS alert at a large academic health system. For patients who screen positive for depression during ambulatory visits, a noninterruptive alert was presented, offering a number of relevant documentation actions. Alert adherence was defined as the selection of any option offered within the alert. We assessed the effect of competing clinical guidance alerts presented during the same encounter and the total of all CDS alerts that the same provider had seen in the prior 90 days, on the probability of depression screen alert adherence, adjusting for physician and patient characteristics.
The depression alert fired during 55 649 office visits involving 418 physicians and 40 474 patients over 41 months. After adjustment, physicians who had seen the most alerts in the prior 90 days were much less likely to respond (adjusted OR highest-lowest quartile, 0.38; 95% CI 0.35-0.42; P < .001). Competing alerts in the same visit further reduced the likelihood of adherence only among physicians in the middle two quartiles of alert exposure in the prior 90 days.
Adherence to a noninterruptive depression alert was strongly associated with the provider's cumulative alert exposure over the past quarter. Health systems should monitor providers' recent alert exposure as a measure of alert fatigue.
临床决策支持（CDS）警报可能会提高医疗质量，但“警报疲劳”会降低提供者的响应能力。我们分析了引入竞争警报如何影响提供者对单一抑郁筛查警报的依从性。
我们分析了大型学术医疗系统中所有 CDS 警报出现的审核数据。对于在门诊就诊时筛查出抑郁症的患者，会显示一个非中断警报，并提供一些相关的文档操作选项。警报依从性定义为在警报中选择任何提供的选项。我们评估了在同一就诊期间出现的竞争临床指导警报以及同一提供者在过去 90 天内看到的所有 CDS 警报的总数对抑郁筛查警报依从性的影响，同时调整了医生和患者的特征。
在 41 个月期间，该抑郁警报在涉及 418 名医生和 40474 名患者的 55649 次就诊中触发。调整后，在过去 90 天内看到最多警报的医生更不可能做出响应（调整后的 OR 最高-最低四分位距，0.38；95%CI 0.35-0.42；P < 0.001）。只有在过去 90 天内处于警报暴露中位数的医生中，同一就诊中的竞争警报进一步降低了依从性的可能性。
对非中断性抑郁警报的依从性与提供者过去一个季度的累积警报暴露密切相关。医疗系统应监测提供者最近的警报暴露情况，作为警报疲劳的衡量标准。
