Acceptability of a decision‐support electronic health record system and its impact on diabetes care goals in South Asia: a mixed‐methods evaluation of the CARRS trial

Abstract

Wider adherence to decision-support electronic health record prompts could potentially improve diabetes goal achievement, particularly when accompanied by assistance from a non-physician health worker.

Clinical Decision Support and Implications for the Clinician Burnout Crisis

“…The 75 non-review, non-opinion articles used a variety of metrics to evaluate the usability and acceptability of their CDS tools, with many using more than one metric. The most common evaluation was via interviews (n=29) 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 , followed by surveys or questionnaires (n=16) 27 29 50 53 55 56 57 58 59 60 61 62 63 64 65 66 . Other qualitative feedback responses were obtained by focus groups or workshops (n=5) 43 57 61 67 68 .…”

“…How often a non-mandatory CDS tool was used, a proxy of whether clinicians found the tool useful and acceptable, was studied in five publications 27 53 56 93 95 . Whether or not a CDS tool made a difference in patient outcomes, such as cardiovascular events 48 , A1c 46 , or mortality 80 , was evaluated in 11 studies 28 43 47 48 77 80 81 82 90 96 97 . Only one study considered the economic cost of a CDS system 48 .…”

“…A hard-stop best practice advisory to promote intensification of blood pressure control in patients with diabetes was successful in increasing treatment, but control of hypertension in the population was not assessed 79 . An evaluation of patient outcomes based on whether the physician accepted or declined CDS found no difference in A1c but statistically significant improvements in blood pressure and low-density lipoprotein (LDL) 46 . As mentioned earlier, a sepsis alert with poor PPV did not change length of stay or mortality 49 .…”

“…Another RCT of a CDS system to assist in the management of patients with cardiovascular risk showed a 2.24% improvement in the surrogate outcome of annual change in predicted 10-year cardiovascular risk [82]. Of the 11 studies that examined CDS effects on end-users as well as patient health outcomes, only two [46,82] showed benefit in some domains.…”

“…Additionally, role-tailoring, in which CDS is targeted to users by role such as nurse, pharmacist, physician, etc., was also seen as a way to reduce burnout and increase acceptability in CDS [21,51]. In one study, non-physician care-coordinators were responsible for data entry to support CDS [46]. In another, nurses rooming patients triggered the CDS [82].…”