| Improving completeness of electronic problem lists through clinical decision support: a randomized, controlled trial. | |
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MedLine Citation:
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PMID: 22215056 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BackgroundAccurate clinical problem lists are critical for patient care, clinical decision support, population reporting, quality improvement, and research. However, problem lists are often incomplete or out of date.ObjectiveTo determine whether a clinical alerting system, which uses inference rules to notify providers of undocumented problems, improves problem list documentation.Study Design and MethodsInference rules for 17 conditions were constructed and an electronic health record-based intervention was evaluated to improve problem documentation. A cluster randomized trial was conducted of 11 participating clinics affiliated with a large academic medical center, totaling 28 primary care clinical areas, with 14 receiving the intervention and 14 as controls. The intervention was a clinical alert directed to the provider that suggested adding a problem to the electronic problem list based on inference rules. The primary outcome measure was acceptance of the alert. The number of study problems added in each arm as a pre-specified secondary outcome was also assessed. Data were collected during 6-month pre-intervention (11/2009-5/2010) and intervention (5/2010-11/2010) periods.Results17 043 alerts were presented, of which 41.1% were accepted. In the intervention arm, providers documented significantly more study problems (adjusted OR=3.4, p<0.001), with an absolute difference of 6277 additional problems. In the intervention group, 70.4% of all study problems were added via the problem list alerts. Significant increases in problem notation were observed for 13 of 17 conditions.ConclusionProblem inference alerts significantly increase notation of important patient problems in primary care, which in turn has the potential to facilitate quality improvement.Trial RegistrationClinicalTrials.gov: NCT01105923. |
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Authors:
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Adam Wright; Justine Pang; Joshua C Feblowitz; Francine L Maloney; Allison R Wilcox; Karen Sax McLoughlin; Harley Ramelson; Louise Schneider; David W Bates |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-1-3 |
Journal Detail:
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Title: Journal of the American Medical Informatics Association : JAMIA Volume: - ISSN: 1527-974X ISO Abbreviation: - Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-1-4 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9430800 Medline TA: J Am Med Inform Assoc Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Division of General Internal Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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