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First published December 15, 2005 as JAMIA PrePrint; doi:10.1197/jamia.M1961
Journal of the American Medical Informatics Association 2006;13(2):171-179
© 2006 American Medical Informatics Association

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Submitted on September 6, 2005
Accepted on November 30, 2005

Improving Ambulatory Prescribing Safety With A Handheld Decision Support System: A Randomized Controlled Trial

Eta S. Berner EdD1*, Thomas K. Houston MD, MPH2, Midge N. Ray RN, MSN1, Jeroan J. Allison MD, MPH1, Gustavo R. Heudebert MD3, W. Winn Chatham MD1, John I. Kennedy Jr MD4, Gerald L. Glandon PhD1, Patricia A. Norton EdD1, Myra A. Crawford PhD1, and Richard S. Maisiak PhD, MSPH1

Affiliation of the authors: 1 University of Alabama at Birmingham, Birmingham, AL; 2 University of Alabama at Birmingham, Birmingham, AL; Deep South Center for Effectiveness Research, Birmingham Veterans Affairs Medical Center, Birmingham, AL; 3 University of Alabama at Birmingham, Birmingham, AL; Birmingham Veterans Affairs Medical Center, Birmingham, AL; 4 Birmingham Veterans Affairs Medical Center, Birmingham, AL; University of Alabama at Birmingham, Birmingham, AL

* To whom correspondence should be addressed.

Objective To evaluate the effectiveness of a PDA-based clinical decision support system (CDSS) on NSAIDs prescribing safety in the outpatient setting.

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 non-steroidal anti-inflammatory drug (NSAID)-related gastrointestinal risk assessment and treatment recommendations. Unannounced Standardized Patients (SPs) trained with 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.

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.

At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p>.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS [0.23 versus 0.45 (F= 4.24, p<.05)]. With the CDSS, intervention participants documented more complete assessment of patient GI-risk from NSAIDs.

Participants provided with a PDA-based CDSS for NSAIDs prescribing made fewer unsafe treatment decisions than participants without the CDSS.




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