TY - JOUR
T1 - Adoption of electronic medical record-based decision support for otitis media in children
AU - Fiks, Alexander G.
AU - Zhang, Peixin
AU - Localio, A. Russell
AU - Khan, Saira
AU - Grundmeier, Robert W.
AU - Karavite, Dean J.
AU - Bailey, Charles
AU - Alessandrini, Evaline A.
AU - Forrest, Christopher B.
N1 - Publisher Copyright:
© Health Research and Educational Trust.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Objective Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence. Study Setting A total of 41,391 OM visits with 108 clinicians at 16 pediatric practices between February 2009 and August 2010. Study Design Prospective cohort study of EHR-based CDS adoption during OM visits, comparing clinicians receiving performance feedback to none. CDS was available to all physicians; use was voluntary. Data Collection Extraction from a common EHR. Principal Findings Clinicians and practices used the CDS system for a mean of 21 percent (range: 0-85 percent) and 17 percent (0-51 percent) of eligible OM visits, respectively. Clinicians who received performance feedback reports summarizing CDS use and guideline adherence had a relative increase in CDS use of 9.0 percentage points compared to others (p =.001). CDS adoption was associated with increased OM guideline adherence. Effects were greatest among clinicians with the lowest adherence prior to the study. Conclusions Performance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows.
AB - Objective Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence. Study Setting A total of 41,391 OM visits with 108 clinicians at 16 pediatric practices between February 2009 and August 2010. Study Design Prospective cohort study of EHR-based CDS adoption during OM visits, comparing clinicians receiving performance feedback to none. CDS was available to all physicians; use was voluntary. Data Collection Extraction from a common EHR. Principal Findings Clinicians and practices used the CDS system for a mean of 21 percent (range: 0-85 percent) and 17 percent (0-51 percent) of eligible OM visits, respectively. Clinicians who received performance feedback reports summarizing CDS use and guideline adherence had a relative increase in CDS use of 9.0 percentage points compared to others (p =.001). CDS adoption was associated with increased OM guideline adherence. Effects were greatest among clinicians with the lowest adherence prior to the study. Conclusions Performance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows.
KW - Decision support
KW - electronic medical record
KW - feedback
KW - otitis media
KW - quality of care
UR - http://www.scopus.com/inward/record.url?scp=84924411141&partnerID=8YFLogxK
U2 - 10.1111/1475-6773.12240
DO - 10.1111/1475-6773.12240
M3 - Article
C2 - 25287670
AN - SCOPUS:84924411141
SN - 0017-9124
VL - 50
SP - 489
EP - 513
JO - Health Services Research
JF - Health Services Research
IS - 2
ER -