Evaluation of the Effect of Decision Support on the Efficiency of Primary Care Providers in the Outpatient Practice

Abstract

Background: Clinical decision support (CDS) for primary care has been shown to improve delivery of preventive services. However, there is little evidence for efficiency of physicians due to CDS assistance. In this article, we report a pilot study for measuring the impact of CDS on the time spent by physicians for deciding on preventive services and chronic disease management. Methods: We randomly selected 30 patients from a primary care practice, and assigned them to 10 physicians. The physicians were requested to perform chart review to decide on preventive services and chronic disease management for the assigned patients. The patients assignment was done in a randomized crossover design, such that each patient received 2 sets of recommendations—one from a physician with CDS assistance and the other from a different physician without CDS assistance. We compared the physician recommendations made using CDS assistance, with the recommendations made without CDS assistance. Results: The physicians required an average of 1 minute 44 seconds, when they were they had access to the decision support system and 5 minutes when they were unassisted. Hence the CDS assistance resulted in an estimated saving of 3 minutes 16 seconds (65%) of the physicians’ time, which was statistically significant (P < .0001). There was no statistically significant difference in the number of recommendations. Conclusion: Our findings suggest that CDS assistance significantly reduced the time spent by physicians for deciding on preventive services and chronic disease management. The result needs to be confirmed by performing similar studies at other institutions.

An approach to improve the care of mid-life women through the implementation of a Women’s Health Assessment Tool/Clinical Decision Support toolkit

“…The WHAT/CDS toolkit was reported to help clinicians prioritize the patients' needs and streamline the patient visit while improving clinician-patient communication. These results were reflective of studies by Wagholikar et al 27 and Edelman et al 11 who found that CDS assistance significantly reduced the time spent by clinicians for deciding on preventive services and chronic disease management while improving delivery of care and enhancing patient engagement.…”

IT‐based clinical knowledge management in primary health care: A conceptual framework

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“…Given the crucial role of organizational innovation in creating a sustainable competitive advantage for business enterprises, its impact upon organizational performance has been previously identified in strategic management research (e.g., Terziovski, ) and IS research in the case of IT‐based innovation (e.g., López‐Nicolás & Meroño‐Cerdán, ; Ordanini & Rubera, ). In primary health care settings, service and process innovations such as e‐prescribing and clinical decision support have been linked to improvements in clinical effectiveness and efficiency (e.g., Schade et al, ; Wagholikar et al, ). Consequently, we formulate our last hypothesis as follows:H8 Higher innovation performance is associated to higher clinical performance.…”

Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

“…Several interventional strategies such as computerised alerts, manual (training‐ or feedback‐based), and estimated GFR (eGFR) prompts provided to physicians have been implemented in patients with CKD to reduce inappropriate prescribing (IP) . Although most of these interventions have been applied in hospital settings, clinical decision support systems have proven to be effective in reducing IP in outpatient and primary care practices as well …”