Outcomes of clinical decision support (CDS) and correlates of CDS use for home care patients with highmedication regimen complexity: a randomized trial.

McDonald MV1, Feldman PH1, Barrón-Vayá Y1, Peng TR1, Sridharan S2, Pezzin LE3.

Author information

Abstract

RATIONALE, AIMS AND OBJECTIVES:

To assess the outcomes of a clinical decision support (CDS) intervention designed for home carepatients with high medication regimen complexity (MRC) and to examine correlates of CDS use.

METHOD:

The CDS consisted of a computerized algorithm that identified high MRC patients, electronic alerts and a care management module. Nurses were randomized upon identification of an eligible patient. Full intention to treat and intervention group-only analyses were completed. Regression-adjusted outcomes were hospitalization, emergency department use and reduction in MRC.

RESULTS:

Five hundred nurses were randomized with 7919 of their patients. Approximately 20% of the intervention group was hospitalized versus 21% in the control group; 16.5% versus 16.7% had an emergency department visit; and 6% in each group dropped below the high MRC threshold. No statistically significant differences were found in the intention to treat analysis. Eighty-two percent of intervention nurses used theCDS but for only 42% of their patients. Among intervention patients, CDS use (vs. non-use) was associated with reduced MRC and hospitalization. CDS use was associated with various clinician and patient characteristics.

CONCLUSION:

CDS use was limited, negating the impact of the intervention overall. Findings on correlates of CDS use and the relationship between CDS use and positive outcomes suggest that CDS use and outcomes could be enhanced by avoiding short patient lengths of stay, improving continuity of care, increasing reliance on salaried nurses and/or increasing per diem nurses' incentives to use CDS.