Effect of a Cognitive Aid on Adherence to Perioperative Assessment and Management Guidelines for the Cardiac Evaluation of Noncardiac Surgical Patients

Abstract Background: The 2007 American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the standard for perioperative cardiac evaluation. Recent work has shown that residents and anesthesiologists do not apply these guidelines when tested. This research hypothesized that a decision support tool would improve adherence to this consensus guideline. Methods: Anesthesiology residents at four training programs participated in an unblinded, prospective, randomized, cross-over trial in which they completed two tests covering clinical scenarios. One quiz was completed from memory and one with the aid of an electronic decision support tool. Performance was evaluated by overall score (% correct), number of incorrect answers with possibly increased cost or risk of care, and the amount of time required to complete the quizzes both with and without the cognitive aid. The primary outcome was the proportion of correct responses attributable to the use of the decision support tool. Results: All anesthesiology residents at four institutions were recruited and 111 residents participated. Use of the decision support tool resulted in a 25% improvement in adherence to guidelines compared with memory alone (P < 0.0001), and participants made 77% fewer incorrect responses that would have resulted in increased costs. Use of the tool was associated with a 3.4-min increase in time to complete the test (P < 0.001). Conclusions: Use of an electronic decision support tool significantly improved adherence to the guidelines as compared with memory alone. The decision support tool also prevented inappropriate management steps possibly associated with increased healthcare costs.

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THE PRIMA-EDS ELECTRONIC DECISION SUPPORT TOOL FOR POLYPHARMACY: A MULTINATIONAL EUROPEAN PROJECT

Innovation in Aging ◽

10.1093/geroni/igx004.3829 ◽

2017 ◽

Vol 1 (suppl_1) ◽

pp. 1048-1048

Author(s):

A. Renom Guiteras ◽

I. Kunnamo ◽

D. Reeves ◽

J. Hoeck ◽

G. Piccoliori ◽

...

Keyword(s):

Decision Support ◽

Decision Support Tool ◽

Electronic Decision Support ◽

Support Tool ◽

European Project

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Effectiveness of the clinical decision support tool ESR eGUIDE for teaching medical students the appropriate selection of imaging tests: randomized cross-over evaluation

European Radiology ◽

10.1007/s00330-020-06942-2 ◽

2020 ◽

Vol 30 (10) ◽

pp. 5684-5689 ◽

Cited By ~ 1

Author(s):

Torsten Diekhoff ◽

Franz Kainberger ◽

Laura Oleaga ◽

Marc Dewey ◽

Elke Zimmermann

Keyword(s):

Decision Support ◽

Medical Students ◽

Clinical Decision Support ◽

Imaging Modality ◽

Decision Support Tool ◽

Clinical Decision ◽

Support Tool ◽

Clinical Scenarios ◽

Group A ◽

Clinical Decision Support Tool

Abstract Objectives To evaluate ESR eGUIDE—the European Society of Radiology (ESR) e-Learning tool for appropriate use of diagnostic imaging modalities—for learning purposes in different clinical scenarios. Methods This anonymized evaluation was performed after approval of ESR Education on Demand leadership. Forty clinical scenarios were developed in which at least one imaging modality was clinically most appropriate, and the scenarios were divided into sets 1 and 2. These sets were provided to medical students randomly assigned to group A or B to select the most appropriate imaging test for each scenario. Statistical comparisons were made within and across groups. Results Overall, 40 medical students participated, and 31 medical students (78%) answered both sets. The number of correctly chosen imaging methods per set in these 31 paired samples was significantly higher when answered with versus without use of ESR eGUIDE (13.7 ± 2.6 questions vs. 12.1 ± 3.2, p = 0.012). Among the students in group A, who first answered set 1 without ESR eGUIDE (11.1 ± 3.2), there was significant improvement when set 2 was answered with ESR eGUIDE (14.3 ± 2.5, p = 0.013). The number of correct answers in group B did not drop when set 2 was answered without ESR eGUIDE (12.4 ± 2.6) after having answered set 1 first with ESR eGUIDE (13.0 ± 2.7, p = 0.66). Conclusion The clinical decision support tool ESR eGUIDE is suitable for training medical students in choosing the best radiological imaging modality in typical scenarios, and its use in teaching radiology can thus be recommended. Key Points • ESR eGUIDE improved the number of appropriately selected imaging modalities among medical students. • This improvement was also seen in the group of students which first selected imaging tests without ESR eGUIDE. • In the student group which used ESR eGUIDE first, appropriate selection remained stable even without the teaching tool.

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Reduction of the long-term use of proton pump inhibitors by a patient-oriented electronic decision support tool (arriba-PPI): study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-019-3728-2 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Anja Rieckert ◽

Annette Becker ◽

Norbert Donner-Banzhof ◽

Annika Viniol ◽

Bettina Bücker ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Decision Support ◽

Controlled Trial ◽

Decision Support Tool ◽

Routine Care ◽

Electronic Decision Support ◽

Support Tool ◽

Randomized Controlled ◽

Cluster Randomized

Abstract Background Proton pump inhibitors (PPIs) are increasingly being prescribed, although long-term use is associated with multiple side effects. Therefore, an electronic decision support tool with the aim of reducing the long-term use of PPIs in a shared decision-making process between general practitioners (GPs) and their patients has been developed. The developed tool is a module that can be added to the so-called arriba decision support tool, which is already used by GPs in Germany in routine care. In this large-scale cluster-randomized controlled trial we evaluate the effectiveness of this arriba-PPI tool. Methods The arriba-PPI tool is an electronic decision support system that supports shared decision-making and evidence-based decisions around the long-term use of PPIs at the point of care. The tool will be evaluated in a cluster-randomized controlled trial involving 210 GP practices and 3150 patients in Germany. GP practices will be asked to recruit 20 patients aged ≥ 18 years regularly taking PPIs for ≥ 6 months. After completion of patient recruitment, each GP practice with enrolled patients will be cluster-randomized. Intervention GP practices will get access to the software arriba-PPI, whereas control GPs will treat their patients as usual. After an observation period of six months, GP practices will be compared regarding the reduction of cumulated defined daily doses of PPI prescriptions per patient. Discussion Our principal hypothesis is that the application of the arriba-PPI tool can reduce PPI prescribing in primary care by at least 15% compared to conventional strategies used by GPs. A positive result implies the implementation of the arriba-PPI tool in routine care. Trial registration German Clinical Trials Register, DRKS00016364. Registered on 31 January 2019.

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Using an Electronic Decision Support Tool to Reduce Inappropriate Polypharmacy and Optimize Medicines: Rationale and Methods

JMIR Research Protocols ◽

10.2196/resprot.5543 ◽

2016 ◽

Vol 5 (2) ◽

pp. e105 ◽

Cited By ~ 6

Author(s):

Amber Young ◽

June Tordoff ◽

Susan Dovey ◽

David Reith ◽

Hywel Lloyd ◽

...

Keyword(s):

Decision Support ◽

Decision Support Tool ◽

Electronic Decision Support ◽

Support Tool

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Reduction of inappropriate medication in older populations by electronic decision support (the PRIMA-eDS project): a survey of general practitioners’ experiences

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocz104 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1323-1332 ◽

Cited By ~ 2

Author(s):

Anja Rieckert ◽

Anne-Lisa Teichmann ◽

Eva Drewelow ◽

Celine Kriechmayr ◽

Giuliano Piccoliori ◽

...

Keyword(s):

Decision Support ◽

Electronic Health Record ◽

General Practitioners ◽

Inappropriate Medication ◽

Decision Support Tool ◽

Health Record ◽

Electronic Decision Support ◽

Support Tool ◽

Electronic Health ◽

Older Populations

Abstract Objective We sought to investigate the experiences of general practitioners (GPs) with an electronic decision support tool to reduce inappropriate polypharmacy in older patients (the PRIMA-eDS [Polypharmacy in chronic diseases: Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support] tool) in a multinational sample of GPs and to quantify the findings from a prior qualitative study on the PRIMA-eDS-tool. Materials and Methods Alongside the cluster randomized controlled PRIMA-eDS trial, a survey was conducted in all 5 participating study centers (Bolzano, Italy; Manchester, United Kingdom; Salzburg, Austria; Rostock, Germany; and Witten, Germany) between October 2016 and July 2017. Data were analyzed using descriptive statistics and chi-square tests. Results Ninety-one (n = 160) percent of the 176 questionnaires were returned. Thirty-two percent of the respondents reported that they did not cease drugs because of the medication check. The 68% who had discontinued drugs comprise 57% who had stopped on average 1 drug and 11% who had stopped 2 drugs or more per patient. The PRIMA-eDS tool was found to be useful (69%) and the recommendations were found to help to increase awareness (86%). The greatest barrier to implementing deprescribing recommendations was the perceived necessity of the medication (69%). The majority of respondents (65%) would use the electronic medication check in routine practice if it was part of the electronic health record. Conclusions GPs generally viewed the PRIMA-eDS medication check as useful and as informative. Recommendations were not always followed due to various reasons. Many GPs would use the medication check if integrated into the electronic health record.

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Analysis of Air Traffic Control Command Entries and the Impact on Decision Support Tool Performance

Air Traffic Control Quarterly ◽

10.2514/atcq.22.1.1 ◽

2014 ◽

Vol 22 (1) ◽

pp. 1-20

Author(s):

Jasenka Rakas ◽

Michael Seelhorst ◽

Bona Bernard Niu ◽

Jeffrey Tom ◽

Confesor Santiago

Keyword(s):

Decision Support ◽

Traffic Control ◽

Air Traffic Control ◽

Decision Support Tool ◽

Air Traffic ◽

Support Tool ◽

Tool Performance ◽

Control Command ◽

The Impact

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Abstract WP290: Impact of TIA Training for General Practitioners on 90-Day Stroke Outcomes Following TIA

Stroke ◽

10.1161/str.47.suppl_1.wp290 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Annemarei Ranta ◽

Susan Dovey ◽

John Gommans ◽

Mark Weatherall

Keyword(s):

Decision Support ◽

General Practitioners ◽

Controlled Trial ◽

Decision Support Tool ◽

Minor Stroke ◽

Education Session ◽

Vascular Events ◽

Electronic Decision Support ◽

Support Tool ◽

Significant Difference

Introduction: The FASTEST trial demonstrated benefit of a TIA/stroke electronic decision support tool for the management of patients with TIA or minor stroke in primary. As part of the trial general practitioners (GPs) were offered an educational session on TIA and stroke prior to trial begin. Hypothesis: GP TIA/stroke education has a beneficial effect on patient outcomes especially if combined with the use of electronic decision support. Methods: The FASTEST trial was a multi-centre, single blind, parallel group, cluster randomised controlled trial comparing TIA/stroke electronic decisions support guided primary care management with usual care. A one-hour pre-trial TIA education session was offered to all participating GPs. Results: Of 181 participating GPs 79 (43.7%) attended a pre-trial education session and 140/291 (48.1%) trial patients were managed by GPs who attended education. Overall, there was no significant difference in 90-day stroke events in patients treated by GPs who attended (2/140 (1.4%)) versus those who did not attend the education session (5/151 (3.3%)); cluster adjusted OR 0.42, 95% CI 0.08-2.21; p=0.30). GP education that was reinforced by subsequent access to the electronic decision support tool during the trial did result in fewer 90-day strokes (0/71; 0%) when compared with patients treated by GPs who neither accessed education nor the TIA/stroke tool (3/50; 6.0%); p=0.033. Similarly there were fewer 90-day vascular events or deaths when education was combined with access to the tool (1/71 (1.4%) versus 8/50 (16%); cluster adjusted OR 0.075, 95%CI 0.02-0.62; p=0.016). When either only the tool or only training were accessed results fell between the extremes with the tool alone performing better than training alone (90-day vascular event or death rate 6/101; 5.9% versus 9/69 13%). Conclusion: GP training alone does not significantly reduce 90-day stroke events following TIA, however, education in combination with access to TIA/stroke electronic decision can enhance the reduction of 90-day stroke and vascular events.

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Transient ischaemic attack and stroke risk: pilot of a primary care electronic decision support tool

Journal of Primary Health Care ◽

10.1071/hc13138 ◽

2013 ◽

Vol 5 (2) ◽

pp. 138 ◽

Cited By ~ 2

Author(s):

Annemarei Ranta

Keyword(s):

Decision Support ◽

User Satisfaction ◽

Transient Ischaemic Attack ◽

Decision Support Tool ◽

Adverse Outcomes ◽

Electronic Decision Support ◽

Support Tool ◽

Transient Ischaemic Attacks ◽

Ischaemic Attack ◽

Record Review

INTRODUCTION: Transient ischaemic attacks (TIAs) indicate high risk for stroke and rapid management reduces stroke burden. Rapid specialist access to initiate timely management is often challenging to achieve. AIM: To assess the feasibility of implementing a TIA/Stroke electronic decision support (EDS) tool intended to aid general practitioners (GPs) in the timely management of TIAs. METHODS: An eight-week pilot provided access to the TIA/Stroke EDS to selected GPs in the MidCentral district, with subsequent patient record review and a post-pilot user satisfaction survey. RESULTS: Eleven patients from eight practices were entered into the tool and when EDS-rendered advice was followed, diagnosis was accurate and management was in accordance with New Zealand TIA guidelines. No adverse outcomes resulted and user feedback was positive. DISCUSSION: Results indicate that wider implementation of the TIA/Stroke EDS tool is feasible. KEYWORDS: Decision support systems; primary health care; software; stroke; transient ischaemic attack

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Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomised controlled trial

BMJ ◽

10.1136/bmj.m1822 ◽

2020 ◽

pp. m1822 ◽

Cited By ~ 9

Author(s):

Anja Rieckert ◽

David Reeves ◽

Attila Altiner ◽

Eva Drewelow ◽

Aneez Esmail ◽

...

Keyword(s):

Decision Support ◽

Confidence Interval ◽

Hospital Admission ◽

Elderly People ◽

Intervention Group ◽

Decision Support Tool ◽

Control Group ◽

Electronic Decision Support ◽

Support Tool ◽

Drug Review

Abstract Objective To evaluate the effects of a computerised decision support tool for comprehensive drug review in elderly people with polypharmacy. Design Pragmatic, multicentre, cluster randomised controlled trial. Setting 359 general practices in Austria, Germany, Italy, and the United Kingdom. Participants 3904 adults aged 75 years and older using eight or more drugs on a regular basis, recruited by their general practitioner. Intervention A newly developed electronic decision support tool comprising a comprehensive drug review to support general practitioners in deprescribing potentially inappropriate and non-evidence based drugs. Doctors were randomly allocated to either the electronic decision support tool or to provide treatment as usual. Main outcome measures The primary outcome was the composite of unplanned hospital admission or death by 24 months. The key secondary outcome was reduction in the number of drugs. Results 3904 adults were enrolled between January and October 2015. 181 practices and 1953 participants were assigned to electronic decision support (intervention group) and 178 practices and 1951 participants to treatment as usual (control group). The primary outcome (composite of unplanned hospital admission or death by 24 months) occurred in 871 (44.6%) participants in the intervention group and 944 (48.4%) in the control group. In an intention-to-treat analysis the odds ratio of the composite outcome was 0.88 (95% confidence interval 0.73 to 1.07; P=0.19, 997 of 1953 v 1055 of 1951). In an analysis restricted to participants attending practice according to protocol, a difference was found favouring the intervention (odds ratio 0.82, 95% confidence interval 0.68 to 0.98; 774 of 1682 v 873 of 1712, P=0.03). By 24 months the number of prescribed drugs had decreased in the intervention group compared with control group (uncontrolled mean change −0.42 v 0.06: adjusted mean difference −0.45, 95% confidence interval −0.63 to −0.26; P<0.001). Conclusions In intention-to-treat analysis, a computerised decision support tool for comprehensive drug review of elderly people with polypharmacy showed no conclusive effects on the composite of unplanned hospital admission or death by 24 months. Nonetheless, a reduction in drugs was achieved without detriment to patient outcomes. Trial registration Current Controlled Trials ISRCTN10137559 .

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