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The objective of this proposal is to compare clinical outcomes, implementation metrics (i.e., patient reach and clinician adoption), and clinician preferences of two designs (customized vs. commercial) of a clinical decision support (CDS). Beta blocker prescribing for patients with heart failure will be used as a test case. The best practices in CDS design, including the user-centered design will be incorporated into the customized CDS and compared to a commercially-available CDS in the electronic health record using a cluster randomized trial.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Customized CDS | Experimental | The customized CDS will be designed and implemented with comprehensive application of known best practice principles in CDS design. The recommendation will be to initiate an evidence-based beta blocker for heart failure. |
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| Commercial CDS | Active Comparator | The commercial CDS is available to all institutions using the Epic electronic health record vendor, but violates some CDS design best practices, notably not being tailored to the end users of a given health system. The recommendation will be to initiate an evidence-based beta blocker for heart failure. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Decision Support Systems, Clinical | Other | Active computerized clinical decision support alert within the electronic health record that recommends initiation of an evidence-based beta blocker for heart failure and reduced ejection fraction. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in prescription of Beta blocker (BB) | Number of prescriptions of an evidence based BB during a primary care office visit. | 6 months post CDS implementation |
| Measure | Description | Time Frame |
|---|---|---|
| Patient Reach | The proportion of unique patients with heart failure who were seen by primary care and not taking an evidence based BB who the CDS fired for. | 6 months post CDS implementation |
| Clinician Adoption |
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Study subjects are providers
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Katy E Trinkley, PharmD | University of Colorado, Denver | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Colorado Health | Aurora | Colorado | 80045 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33749610 | Derived | Trinkley KE, Kroehl ME, Kahn MG, Allen LA, Bennett TD, Hale G, Haugen H, Heckman S, Kao DP, Kim J, Matlock DM, Malone DC, Page Nd RL, Stine J, Suresh K, Wells L, Lin CT. Applying Clinical Decision Support Design Best Practices With the Practical Robust Implementation and Sustainability Model Versus Reliance on Commercially Available Clinical Decision Support Tools: Randomized Controlled Trial. JMIR Med Inform. 2021 Mar 22;9(3):e24359. doi: 10.2196/24359. |
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| ID | Term |
|---|---|
| D006333 | Heart Failure |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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The proportion of CDS who were not outright dismissed by the clinician.
| 6 months post CDS implementation |
| Factors Influencing Clinician Adoption of the CDS per Qualitative Interviews | Clinician-reported factors that influence adoption of the CDS. | 6 months post CDS implementation |