RESUMO
OBJECTIVE: To evaluate whether a new documentation-based clinical decision support system (CDSS) is effective in addressing deficiencies in the care of patients with coronary artery disease (CAD) and diabetes mellitus (DM). STUDY DESIGN: Controlled trial randomized by physician. METHODS: We assigned primary care physicians (PCPs) in 10 ambulatory practices to usual care or the CAD/DM Smart Form for 9 months. The primary outcome was the proportion of deficiencies in care that were addressed within 30 days after a patient visit. RESULTS: The Smart Form was used for 5.6% of eligible patients. In the intention-to-treat analysis, patients of intervention PCPs had a greater proportion of deficiencies addressed within 30 days of a visit compared with controls (11.4% vs 10.1%, adjusted and clustered odds ratio =1.14; 95% confidence interval, 1.02-1.28; P = .02). Differences were more pronounced in the "on-treatment" analysis: 17.0% of deficiencies were addressed after visits in which the Smart Form was used compared with 10.6% of deficiencies after visits in which it was not used (P <.001). Measures that improved included documentation of smoking status and prescription of antiplatelet agents when appropriate. CONCLUSIONS: Overall use of the CAD/DM Smart Form was low, and improvements in management were modest. When used, documentation-based decision support shows promise, and future studies should focus on refining such tools, integrating them into current electronic health record platforms, and promoting their use, perhaps through organizational changes to primary care practices.
Assuntos
Doença da Artéria Coronariana/terapia , Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Diabetes Mellitus/terapia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Doença Crônica/terapia , Registros Eletrônicos de Saúde , Humanos , Análise de Intenção de Tratamento , Massachusetts , Avaliação de Resultados em Cuidados de Saúde , Médicos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricosRESUMO
Clinical Decision Support Systems (CDSS) have the potential to improve patient care. We developed the Coronary Artery Disease and Diabetes Mellitus (CAD/DM) Smart Form as a documentation-based application that provides decision support for the management of chronic diseases. Results of a pilot study suggest that the CAD/DM Smart Form has the potential to improve patient care.