Impact of EHR-Based Clinical Decision Support on Adherence to Guidelines for Patients on NSAIDs: A Randomized Controlled Trial

Abstract

PURPOSE Electronic health records (EHRs) with clinical decision support hold promise for improving quality of care, but their impact on management of chronic conditions has been mixed. This study examined the impact of EHR-based clinical decision support on adherence to guidelines for reducing gastrointestinal complications in primary care patients on nonsteroidal anti-infl ammatory drugs (NSAIDs). METHODSThis randomized controlled trial was conducted in a national network of primary care offi ces using an EHR and focused on patients taking traditional NSAIDs who had factors associated with a high risk for gastrointestinal complications (a history of peptic ulcer disease; concomitant use of anticoagulants, antiplatelet medications [including aspirin], or corticosteroids; or an age of 75 years or older). The offi ces were randomized to receive EHR-based guidelines and alerts for high-risk patients on NSAIDs, or usual care. The primary outcome was the proportion of patients who received guideline-concordant care during the 1-year study period (June 2007-June 2008), defi ned as having their traditional NSAID discontinued (including a switch to a lower-risk medication), having a gastroprotective medication coprescribed, or both. RESULTSParticipants included 27 offi ces with 119 clinicians and 5,234 highrisk patients. Intervention patients were more likely than usual care patients to receive guideline-concordant care (25.4% vs 22.4%, adjusted odds ratio = 1.19; 95% confi dence interval, 1.01-1.42). For individual high-risk groups, patients on low-dose aspirin were more likely to receive guideline-concordant care with the intervention vs usual care (25.0% vs 20.8%, adjusted odds ratio = 1.30; 95% confi dence interval, 1.04-1.62), but there was no signifi cant difference for patients in other high-risk groups.CONCLUSIONS This study showed only a small impact of EHR-based clinical decision support for high-risk patients on NSAIDs in primary care offi ces. These results add to the growing literature about the complexity of EHR-based clinical decision support for improving quality of care.

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