Improving Ambulatory Prescribing Safety with a Handheld Decision Support System: A Randomized Controlled Trial
- Eta S Berner,
- Thomas K Houston,
- Midge N Ray,
- Jeroan J Allison,
- Gustavo R Heudebert,
- W Winn Chatham,
- John I Kennedy Jr,
- Gerald L Glandon,
- Patricia A Norton,
- Myra A Crawford,
- Richard S Maisiak
- Affiliations of the authors: University of Alabama at Birmingham, Birmingham, AL (ESB, TKH, MNR, JJA, GRH, WWC, JIK, GLG, PAN, MAC, RSM); Deep South Center for Effectiveness Research, Birmingham Veterans Affairs Medical Center, Birmingham, AL (TKH); Birmingham Veterans Affairs Medical Center, Birmingham, AL (GRH, JIK)
- Correspondence and reprint requests: Eta S. Berner, EdD, Department of Health Services Administration, University of Alabama at Birmingham, 1675 University Boulevard, Room 544, Birmingham, AL 35294-3361; e-mail: <eberner{at}uab.edu>
- Received 6 September 2005
- Accepted 30 November 2005
Abstract
Objective To evaluate the effectiveness of a personal digital assistant (PDA)–based clinical decision support system (CDSS) on nonsteroidal anti-inflammatory drug (NSAID) prescribing safety in the outpatient setting.
Design The design was a randomized, controlled trial conducted in a university-based resident clinic. Internal medicine residents received a PDA-based CDSS suite. For intervention residents, the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations. Unannounced standardized patients (SPs) trained to portray musculoskeletal symptoms presented to study physicians. Safety outcomes were assessed from the prescriptions given to the SPs. Each prescription was reviewed by a committee of clinicians blinded to participant, intervention group assignment, and baseline or follow-up status.
Measurements Prescriptions were judged as safe or unsafe. The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group.
Results At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p > 0.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS (0.23 vs. 0.45 [F = 4.24, p < 0.05]). With the CDSS, intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs.
Conclusion Participants provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS.
Footnotes
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This research was supported in part by grant # R18 HS 11820 from the Agency for Healthcare Research and Quality.
The authors thank Robyn Tamblyn, PhD, for providing materials and valuable consultation in regard to the use of Standardized Patients and Gurkipal Singh, MD, for permission to use the SCORE© rule in this research. They also acknowledge the assistance of Tonya La Lande, Meg Bruck, and David Sloan for assistance in developing MedDecide and assistance in data acquisition.
