Provider-Focused Intervention to Promote Comprehensive Screening for Adolescent Idiopathic Scoliosis by Primary Care Pediatricians

Diaz, Maria Carmen G.; Wysocki, Tim; Crutchfield, James H.; Franciosi, James P.; Werk, Lloyd N.

doi:10.1177/1062860618792667

Cited by 6 publications

(2 citation statements)

References 10 publications

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“…On the one hand, the extreme heterogeneity indicates non-random variation in effect sizes, such that a minority of interventions might have achieved significantly larger effects than the 95% confidence intervals around the meta-analytic average. Indeed, 25% of studies reported absolute improvements greater than 10%, with one as high as 62% 67. Yet, even with the identification of two significant predictors of larger effects—namely, paediatric studies and those with low baseline adherence—the meta-regression model still showed extreme heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, 25% of studies reported absolute improvements greater than 10%, with one as high as 62%. 67 Yet, even with the identification of two significant predictors of larger effects—namely, paediatric studies and those with low baseline adherence—the meta-regression model still showed extreme heterogeneity. Thus even when these characteristics were taken into account, a wide, non-random variation remained in the improvements seen with clinical decision support systems.…”

Section: Discussionmentioning

confidence: 99%

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Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials

Kwan

Ferguson

et al. 2020

BMJ

259

214

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Objective To report the improvements achieved with clinical decision support systems and examine the heterogeneity from pooling effects across diverse clinical settings and intervention targets. Design Systematic review and meta-analysis. Data sources Medline up to August 2019. Eligibility criteria for selecting studies and methods Randomised or quasi-randomised controlled trials reporting absolute improvements in the percentage of patients receiving care recommended by clinical decision support systems. Multilevel meta-analysis accounted for within study clustering. Meta-regression was used to assess the degree to which the features of clinical decision support systems and study characteristics reduced heterogeneity in effect sizes. Where reported, clinical endpoints were also captured. Results In 108 studies (94 randomised, 14 quasi-randomised), reporting 122 trials that provided analysable data from 1 203 053 patients and 10 790 providers, clinical decision support systems increased the proportion of patients receiving desired care by 5.8% (95% confidence interval 4.0% to 7.6%). This pooled effect exhibited substantial heterogeneity (I 2 =76%), with the top quartile of reported improvements ranging from 10% to 62%. In 30 trials reporting clinical endpoints, clinical decision support systems increased the proportion of patients achieving guideline based targets (eg, blood pressure or lipid control) by a median of 0.3% (interquartile range −0.7% to 1.9%). Two study characteristics (low baseline adherence and paediatric settings) were associated with significantly larger effects. Inclusion of these covariates in the multivariable meta-regression, however, did not reduce heterogeneity. Conclusions Most interventions with clinical decision support systems appear to achieve small to moderate improvements in targeted processes of care, a finding confirmed by the small changes in clinical endpoints found in studies that reported them. A minority of studies achieved substantial increases in the delivery of recommended care, but predictors of these more meaningful improvements remain undefined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials

Kwan

Ferguson

et al. 2020

BMJ

259

214

View full text Add to dashboard Cite

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The effects of on-screen, point of care computer reminders on processes and outcomes of care

Shojania

Jennings²,

Mayhew

et al. 2009

Cochrane Database of Systematic Reviews

362

339

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Background The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering ‘computer reminders’. Objectives To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. Search methods We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. Selection criteria Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. Data collection and analysis Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. Main results Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). Authors’ conclusions Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.

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Spinal Deformities in the Adolescent Athlete

Bachmann

2021

Clinics in Sports Medicine

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Provider-Focused Intervention to Promote Comprehensive Screening for Adolescent Idiopathic Scoliosis by Primary Care Pediatricians

Cited by 6 publications

References 10 publications

Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials

Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials

The effects of on-screen, point of care computer reminders on processes and outcomes of care

Spinal Deformities in the Adolescent Athlete

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