View source for Efficacy of an Evidence-Based Clinical Decision Support in Primary Care Practices A Randomized Clinical Trial


This is a phase 2 or follow up of a randomized clinical trial to evaluate the efficacy of iCPR tool usage and reduced redundant antibiotic orders by enrolled providers. This trial was conducted by McGinn et al.  <ref name="McGinn"> McGinnT.G., McCullagh,L., Kannry,J., Knaus,M.,Sofianou,A., Wisnivesky,J.P., Mann,D,M. Efficacy of an Evidence-Based Clinical Decision Support in Primary Care Practices
A Randomized Clinical Trial. JAMA Intern Med. 2013; 173(17):1584-1591. doi:10.1001/jamainternmed.2013.8980. Retrived from http://www.ncbi.nlm.nih.gov/pubmed/23896675.</ref>

=Research question=
The implemented iCPR tool diagnosed streptococcal pharyngitis and pneumonia patients as per CPR risk calculator and corresponding antibiotic prescribing rate had been utilized effectively and adopted efficiently.<ref name="McGinn"></ref>

=Objective=	
To report the progress of the impact of introducing two clinical prediction tools in primary care.<ref name="McGinn"></ref>

=Design, settings and participants=
This follow-up trial was conducted at 2 large urban ambulatory primary care practices Mount Sinai School of Medicine. The tool was activated for 586 providers in intervention group from November 1, 2010, through October 31, 2011. Providers (586) in control group had knowledge about the tool.<ref name="McGinn"></ref> 

=Interventions, outcomes and measures= 

==Outcomes==
•	Primary outcomes measures were differences in provider prescribing patterns based on patient demographics between control and intervention groups 
•	Distribution and type of antibiotics prescribed after using the CPR risk score calculator and bundled order sets.
Rates of ordering of chest radiographs, rapid streptococcal tests, and pharyngitis throat cultures 

•	Process outcomes measures
The provider opening the tool once triggered, completion of the risk score calculator embedded in the tool, viewing and signing the bundled order set associated with the score generated.<ref name="McGinn"></ref>

==Statistical analysis==
Analyses were conducted with statistical software (SAS,version 9.2; SAS Institute, Inc) using 2-sided P values.<ref name="McGinn"></ref>

=Results= 

The statistically significant differences were observed between intervention and control groups 
•	median ages of the patients 
•	antibiotic prescribing, 
•	rapid streptococcal testing, and 
•	pharyngitis throat cultures ordering
Process outcomes
About 40.44% in control group and 59.55% in intervention group had seen and used the tool respectively.<ref name="McGinn"></ref>

=Discussion= 
The overall adoption rates in this study were higher by about 40% more than other similar studies. 
A significant reduction was observed for antibiotics prescribed in pneumonia patients compared to pharyngitis patients in the intervention group.The results attributed to providers perception of the tool as a useful aid to the clinical diagnosis of pharyngitis and pneumonia, enhancing clinical work flow and improving patient care. High adoption rates were a result of the comprehensive [[User centered design]] and development process including pilot testing with providers, [[Usability]] testing, focused user training on [[CDS]] collaboration with a multidisciplinary team that included experts in usability and informatics and CDS specialists.<ref name="McGinn"></ref>

=Conclusion= 
This study was fruitful not only in implementation and minimize unnecessary testing and cultures and corresponding antibiotic ordering but also more than anticipated adoption rate by providers of a complex decision support tool integrated evidence-based diagnostic tools at the point of care. <ref name="McGinn"></ref>

=Comments=
This study enlightens many areas to be focused for the seamless workflow integration of Evidence based medicine CPR tools into [[EMR]].
These studies should still need to be applied to more diverse departments in healthcare.

=References=
<references/>

[[Category: Reviews]]
[[Category: CDS]]
[[Category: EMR]]
[[category: Workflow]]