Comparing Effects of Patient-specific Versus Non-patient-specific Computerized Reminder System

Taipei Medical University90 enrolled

Overview

The investigators hypothesize that a Clinical Decision Support System (CDSS) designed with "Patient-Specific" reminders yields superior performance than that with "Non-patient-specific" reminders in preventing contrast-induced nephropathy.

We hypothesize that a clinical decision support system (CDSS) designed with "Patient-specific" reminders yields superior performance than that with "Non-patient-specific" reminders in preventing contrast-induced nephropathy. A 3-arm randomized controlled trial (RCT) will be performed by cluster randomization using physicians as the unit of allocation. Physicians in 3 university medical centers will be randomly assigned into 1) patient-specific arm with Anti Contrast-Induced-Nephropathy(Anti-CIN) reminder, 2) non-patient-specific reminder arm, and 3) the control arm without any reminders, respectively. The patient-specific alert, Anti-CIN system, is designed as a real-time CDSS implementation on CPOE for monitoring physician's contrast-enhanced CT and IVP orders. Computerized pop-up reminders provide the patient-specific encounters with optimal decision options when patients are at a high CIN risk or patients with unknown risk factors are encountered. Non-patient-specific reminders always pop up no matter whether the patient is at a high risk or not.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Radiographic Contrast Agent Nephropathy

Interventions

Patient-specific computerized reminderOTHER

The intervention targets are physicians,not patients. This CDSS alerts physicians only when the patient with high risk of contrast-induced-nephropathy(CIN) is encountered. On the contrast, the CDSS will not alert when the patient without CIN risk is encountered.

Non-patient-specific computerized reminderOTHER

The non-patient-specific computerized reminder always pops up to remind physicians to check their patient's CIN risk no matter what CIN risk is.

Eligibility

Sex: ALLMin age: 25 YearsMax age: 70 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Our intervention targets are physicians but not patients. All physicians working in the hospital may join this trial. Exclusion Criteria: * The physician who never orders a CT scan or IVU study will be excluded * The physician who never operates the CPOE by himself or herself will be excluded

Locations (1)

Taipei medical university hospital

Taipei, Taiwan

Outcomes

Primary Outcomes

The percentage of contrast-enhanced imaging(CEI) orders with high CIN risk

The number of CEI ordered for patients at high CIN risk, divided by the total number of CEI orders. \[CEI\]: contrast-enhanced image studies,such as CT or IVU. \[CIN\]: contrast-induced nephropathy

Time frame: Physicains who participated in this trial will be followed for an expected average of 12 months

Secondary Outcomes

The order elimination rate of high CIN risk orders attributed to the computerized reminder

The number of CEI orders with high CIN risk cancelled by the physician attributed to our computerized reminder, divided by the total number of CEI orders with high CIN risk.

Time frame: Physicains who participated in this trial will be followed for an expected average of 12 months

Data from ClinicalTrials.gov

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