Key Points Question Can clinical decision support plus practice facilitation improve treatment of chronic kidney disease (CKD) in primary care, with the goal of delaying progression of CKD from stages 3 and 4? Findings This cluster randomized clinical trial of 30 primary care practices comprising 6699 patients showed a significant effect in the intervention group compared with the control group in slowing the annualized loss of estimated glomerular filtration rate in patients with stages 3 and 4 CKD. There was significant improvement in hemoglobin A 1c over time among patients in the intervention group compared with patients in the control group, with an imbalance between groups resulting from practice dropout posing a significant limitation. Meaning Findings suggest that a multimodal intervention in primary care can slow the progression of stages 3 and 4 CKD.

Obiective: letWith the advent of hospital payment by diagnosis-related group (DRG), length of stay (LOS) has become a major issue in hospital efforts to control costs. Because the Columbia-Presbyterian Medical Center (CPMC) has had above-average LOSS for many DRGs, the authors tested the hypothesis that a computer-generated informational message directed to physicians would shorten LOS.Design: Randomized clinical trial with the patient as the unit of randomization.Setting and Study Population: From June 1991 to April 1993, at CPMC in New York, 7,109 patient admissions were randomly assigned to an intervention (informational message) group and 6,990 to a control (no message) group. Intervention:A message giving the average LOS for the patient's admission or provisional DRG, as assigned by hospital utilization review, and the current LOS, in days, was included in the main menu for review of test results in the hospital's clinical information system, available at all nursing stations in the hospital.Main Outcome Measure: Hospital LOS.Results: The median LOS for study patients was 7 days. After adjustment for covariates including age, sex, payor, patient care unit, and time trends, the mean LOS in the intervention group was 3.2% shorter than that in the control group (p = 0.022).Conclusion: Computer-generated patient-specific LOS information directed to physicians was associated with a reduction in hospital LOS. n J Am Med Informatics Assoc. 1995;2:58-64.

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