Special Article
Computerized Decision Support Based on a Clinical Practice Guideline Improves Compliance with Care Standards

https://doi.org/10.1016/S0002-9343(96)00382-8Get rights and content

Abstract

PURPOSE: Clinical guidelines are designed to assist in the management of specific diseases; however, these guidelines are often neglected in the delivery of care. The purpose of this study was to determine whether clinician use of a clinical practice guideline would increase in response to having, at the patient visit, a decision support system based on a practice guideline that generates a customized management protocol for the individual patient using data from the patient's electronic medical record.

SUBJECTS AND METHODS: In a 6-month controlled trial at a primary care clinic, 58 primary care clinicians were randomized to receive either a special encounter form with the computer-generated guideline recommendations or a standard encounter form. The effect of computer-generated advice on clinician behavior was measured as rate of compliance with guideline recommendations. Data from 30 clinicians were analyzed; data from 28 clinicians were excluded because these clinicians did not meet predefined criteria for minimum exposure to diabetic patient care.

RESULTS: Availability of patient management recommendations generated by the decision support system resulted in a two-fold increase in clinician compliance with care guidelines for diabetes mellitus (P = 0.01). Median compliance for the group receiving the recommendations was 32.0% versus 15.6% for the control group.

CONCLUSION: Decision support based on a clinical practice guideline is an effective tool for assisting clinicians in the management of diabetic patients. This decision support system provides a model for how a clinical practice guideline can be integrated into the care process by computer to assist clinicians in managing a specific disease through helping them comply with care standards. Use of decision support systems based on clinical practice guidelines could ultimately improve the quality of medical care.

Section snippets

Study Design

The effect of the Computer-Assisted Management Protocol on clinician compliance with guidelines was evaluated in a 6-month, randomized, controlled trial conducted at the Duke Family Medicine Center at Duke University Medical Center. Duke Family Medicine Center is a free-standing, primary care clinic that offers on site laboratory testing, radiology studies, and pharmacy services. It is also the primary outpatient clinic site for the Duke University Family Medicine Residency Program. In 1993,

Derivation of Compliance Data

Initially, 497 patients were identified for possible inclusion in the study based on a listing of diabetes on their electronic problem list and on having at least one encounter during the study period with a clinician enrolled in the study. Four hundred eighty-three charts (97.2%) were available for auditing. In 81 of the audited charts (16.8%), the diagnosis of diabetes incorrectly appeared on the patient's electronic problem list. Most of these incorrect diagnoses reflected errors in data

Discussion

The Computer-Assisted Management Protocol significantly improved clinician compliance with care guideline recommendations for diabetes. This finding demonstrates that a clinical practice guideline can be used to assist directly with patient management and validates the Computer-Assisted Management Protocol as a tool to assist clinicians in the management of diabetes mellitus by integrating medical knowledge at the point of care. While this study has shown that the Computer-Assisted Management

Acknowledgements

The authors wish to thank James Collins, PhD, for programming assistance; Kimberly S. H. Yarnall, MD., for suggestions concerning the clinical implementation of the Computer-Assisted Management Protocol; and Jonathan Prather, BS, for assistance with database queries.

This work was supported in part by grant 1-T15-LM07071 from the National Library of Medicine.

References (28)

  • AG Ellrodt et al.

    Measuring and improving physician compliance with clinical practice guidelines. A controlled interventional trial

    Ann Intern Med.

    (1995)
  • CJ McDonald

    Protocol-based computer reminders, the quality of care and the non-perfectability of man

    NEJM

    (1976)
  • CJ McDonald et al.

    Reminders to physicians from an introspective computer medical record: a two-year randomized trial

    Ann Intern Med.

    (1984)
  • WW Rosser et al.

    Use of reminders for preventive procedures in family medicine

    Can Med Assoc J.

    (1991)
  • Cited by (0)

    View full text