Comparative Effectiveness of Best Practice Alerts with Active and Passive Presentations: A Retrospective Study

Abstract

We assess the relationship of active or passive presentation of Best Practice Advisories (BPAs) for hospital clinicians with compliance rates of recommended actions. We identify the design characteristics of alerts that can be used to assess the effectiveness of design choices with superior usability. Alerts in Electronic Health Records (EHRs) are frequently overridden by healthcare providers. Identifying characteristics of effective alerts can increase the frequency that actions recommended in evidence-based care guidelines are done, reduce user frustration, and improve interface usability along with the willingness to use alerts. We conducted a retrospective analysis of data for 11 BPAs between June 2014 and May 2015. The outcome measure was the percent correspondence with recommended actions. A repeated measures regression model was used for the correlation of the BPA presentation type with the outcome measure. The BPA presentation type was significant such that the odds are 7.7 times greater that a recommended action would be taken by a provider with an active BPA presentation type after adjusting for whether an action was required. Active presentation alerts achieve higher compliance rates. CDS alerts that actively interrupted the provider’s workflow were associated with a higher compliance rate with recommended actions.

Staff Knowledge, Attitudes, and Beliefs About Child Sugar-Sweetened Beverage Intake and Acceptability of a Pediatric Clinic-Based Beverage Screener

“…This evidence continues to be supported even when alerts can be dismissed or deferred without completing the required action. 16 The active presentation and automatic design of the BPA in this study were consistent with characteristics recommended in other studies with higher compliance rates. 16 Despite high posttraining levels of support and enthusiasm for the SSB BPA among survey respondents, in the 6 months after the SSB screener was activated across the health system (March through September 2020), only 47% of children in participating clinics had up-to-date SSB and FJ screening data documented in the EHR.…”

“…16 The active presentation and automatic design of the BPA in this study were consistent with characteristics recommended in other studies with higher compliance rates. 16 Despite high posttraining levels of support and enthusiasm for the SSB BPA among survey respondents, in the 6 months after the SSB screener was activated across the health system (March through September 2020), only 47% of children in participating clinics had up-to-date SSB and FJ screening data documented in the EHR. During the online training, staff were instructed to complete the BPA whenever it fired, regardless of visit type; however, the BPA was not mandatory and could be exited without completion.…”

“…An active presentation type that actively interrupts the clinician's workflow has been found to be associated with a higher compliance rate of recommended actions. This evidence continues to be supported even when alerts can be dismissed or deferred without completing the required action 16 . The active presentation and automatic design of the BPA in this study were consistent with characteristics recommended in other studies with higher compliance rates 16 …”

Multicomponent behavioral intervention to reduce exposure to anticholinergics in primary care older adults

“…Neither provider‐ nor patient‐focused alerts employed in our study forced a decision but were noninterruptive or passive in nature, potentially explaining the low rate of acceptance. Interruptive alerts that force an interaction, for example, default to a change in medication or require a justification for refusal carries ethical considerations that limit use but may be more effective in provoking change 32 …”

“…However, there are alternative approaches for increasing demand, including more effective nudges than those employed in our intervention. Providers may have viewed deprescribing as an unplanned or low‐priority activity 32 . Until the practice of deprescribing is normalized in routine clinical care, or timing of alerts can be improved with contextual awareness, deprescribing alerts may continue to be unsuccessful.…”