| Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation. | |
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MedLine Citation:
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PMID: 21920302 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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PURPOSE: To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, or repeated sooner than recommended due to preparation (prep) quality; prep quality; colonoscopy duration; and patient satisfaction with and tolerance of the preparation. METHODS: We used 4 alternating 4-week periods to compare the decision tool with usual care for outpatient colonoscopy. All decision tool decisions were reviewed in real-time by gastroenterology nurses and/or physicians. Patients completed a survey about the prep process. Endoscopists blindly rated prep quality. Colonoscopy duration and findings were recorded. RESULTS: Of 354 persons in the decision tool group, 4 prep decisions were overridden because of patient preference or prior prep failure, but none for medical reasons. Sodium phosphate was used more frequently in the decision tool group (73% vs. 41%; P<0.01). There was no difference between the decision tool and usual care groups in the composite outcome (26% vs. 30%, respectively; P=0.29), acceptable prep quality (62% vs. 56%; P=0.22), colonoscopy duration (28 vs. 30min; P=0.17), patient satisfaction (P=0.38), or preparation tolerance (P=0.37). CONCLUSIONS: An electronic medical record-based decision tool can safely and effectively tailor the prep for colonoscopy and may improve colonoscopy efficiency and patient satisfaction. LIMITATIONS: This study was performed at a single VA medical center and endoscopy unit, relies on the presence of relevant medical conditions and laboratory data in the electronic medical record, and had a higher than expected use of sodium phosphate during usual care. |
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Authors:
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Thomas F Imperiale; Eric A Sherer; Jo Ann D Balph; Jon D Cardwell; Rong Qi |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: International journal of medical informatics Volume: 80 ISSN: 1872-8243 ISO Abbreviation: Int J Med Inform Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-09-16 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9711057 Medline TA: Int J Med Inform Country: Ireland |
Other Details:
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Languages: eng Pagination: 726-33 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Elsevier Ireland Ltd. All rights reserved. |
Affiliation:
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Center of Excellence for Implementation of Evidence-based Research, Health Services Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States; Indiana University Medical Center, Indianapolis, IN, United States; The Regenstrief Institute, Inc, Indianapolis, IN, United States. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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