Randomized controlled trial evaluating the benefit of the app-based clinical decision support system for the management of venous thromboembolism.

INTRODUCTION

Anticoagulant prescription and management are crucial steps of management of venous thromboembolism (VTE). The Clinical decision support systems (CDSS) are designed and developed to aid healthcare professionals in making informed decisions.

OBJECTIVES

To develop and assess the efficacy the mobile app-based CDSS for the management of VTE.

METHODS

A randomized controlled trial was conducted, enrolling participants aged ≥ 20 years who were one of the following categories: medical student, intern, internal medicine resident, or hematology fellow. Participants were randomly assigned to either app-based CDSS (DECIDE-COAG) or control groups. Participants were tasked with prescribing or planning the management of 15 clinical vignettes covering four domains: anticoagulant dosing, perioperative management, management of anticoagulant associated bleeding and diagnosis of VTE. The primary outcome was the mean percentage of accuracy score.

RESULTS

From September 2023 through November 2023, a total of 126 participants were enrolled. The mean percentage of accuracy score was significantly higher (95.6%) in participants using app-based CDSS compared with those in control group (41.3%), a mean difference of 54.5%, 95% CI 49.8-59.2, p < 0.001. The satisfaction mean score was 4.57 ± 0.49 for accessibility, 4.73 ± 0.45 for app stability, 4.94 ± 0.25 for user interface, 4.78 ± 0.42 for simplicity, 4.98 ± 0.13 for assistance in decision-making and 4.90 ± 0.30 for overall satisfaction.

CONCLUSIONS

App-based CDSS (DECIDE-COAG) demonstrates a significant improvement in the accuracy of anticoagulant prescriptions and VTE management. Further studies that specifically investigate the clinical benefits of app-based CDSS in real-world clinical practice are warranted.

CLINICAL TRIAL NUMBER

TCTR20241117004.