User Actions Within a Clinical Decision Support Alert for the Management of Hypertension in Chronic Kidney Disease.

IF 2.1 2区医学 Q4 MEDICAL INFORMATICS

Applied Clinical Informatics Pub Date : 2025-03-17 DOI:10.1055/a-2554-3969

Lipika Samal, Sarah W Chen, Stuart Lipsitz, Heather J Baer, John L Kilgallon, Michael P Gannon, Ryan Dunk, Weng Ian Chay, Richard Fay, Michael Sainlaire, Chenxi Gao, Matthew Wien, Pamela Garabedian, Edward Wu, Hojjat Salmasian, David W Bates, Patricia Dykes, Adam Wright, Allison B McCoy

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引用次数: 0

Abstract

Objective: To examine user actions within a clinical decision support (CDS) alert addressing hypertension (HTN) in chronic kidney disease (CKD).

Methods: A pragmatic randomized controlled trial of a CDS alert for primary care patients with CKD and uncontrolled blood pressure included pre-checked default orders for medication initiation or titration, basic metabolic panel (BMP), and nephrology electronic consult. We examined each type of action and calculated percentages of placed and signed orders for subgroups of firings.

Results: There were firings for medication initiation (813) and medication titration (430), and every firing also included orders for nephrology electronic consult (1243) and BMP (1243). High rates of override (59.6%) and deferral (14.6%) were observed, and CDS-recommended orders were only signed about one-third of the time from within the alert. The percentage of orders that were signed after being placed within the alert was higher for medication initiation than for medication titration (33% vs 12.0% for angiotensin-converting enzyme inhibitors (ACEi), 38.8% vs 14% for angiotensin II receptor blockers (ARB).

Discussion: Findings suggest that users are hesitant to commit to immediate action within the alert.

Conclusion: Evaluating user interaction within alerts reveals nuances in physician preferences and workflow that should inform CDS alert design.

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来源期刊

Applied Clinical Informatics MEDICAL INFORMATICS-

CiteScore

4.60

自引率

24.10%

发文量

132

期刊介绍： ACI is the third Schattauer journal dealing with biomedical and health informatics. It perfectly complements our other journals Öffnet internen Link im aktuellen FensterMethods of Information in Medicine and the Öffnet internen Link im aktuellen FensterYearbook of Medical Informatics. The Yearbook of Medical Informatics being the “Milestone” or state-of-the-art journal and Methods of Information in Medicine being the “Science and Research” journal of IMIA, ACI intends to be the “Practical” journal of IMIA.