This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (56)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Venous Thromboembolism  • Alert me on articles by topic

Effect on Physician Behavior

Pierre Durieux, MD, MPH; Rémy Nizard, MD; Philippe Ravaud, MD, PhD; Nicolas Mounier, MD; Eric Lepage, MD, PhD

JAMA. 2000;283:2816-2821.

Context  Computer-based clinical decision support systems (CDSSs) have been promoted for their potential to improve quality of health care. However, given the limited range of clinical settings in which they have been tested, such systems must be evaluated rigorously before widespread introduction into clinical practice.

Objective  To determine whether presentation of venous thromboembolism prophylaxis guidelines using a CDSS increases the proportion of appropriate clinical practice decisions made.

Design  Time-series study conducted between December 1997 and July 1999.

Setting  Orthopedic surgery department of a teaching hospital in Paris, France.

Participants  A total of 1971 patients who underwent orthopedic surgery.

Intervention  A CDSS designed to provide immediate information pertaining to venous thromboembolism prevention among surgical patients was integrated into daily medical practice during three 10-week intervention periods, alternated with four 10-week control periods, with a 4-week washout between each period.

Main Outcome Measure  Proportion of appropriate prescriptions ordered for anticoagulation, according to preestablished clinical guidelines, during intervention vs control periods.

Results  Physicians complied with guidelines in 82.8% (95% confidence interval [CI], 77.6%-87.1%) of cases during control periods and in 94.9% (95% CI, 92.5%-96.6%) of cases during intervention periods. During each intervention period, the appropriateness of prescription increased significantly (P<.001). Each time the CDSS was removed, physician practice reverted to that observed before initiation of the intervention. The relative risk of inappropriate practice decisions during control periods vs intervention periods was 3.8 (95% CI, 2.7-5.4).

Conclusions  In our study, implementation of clinical guidelines for venous thromboembolism prophylaxis through a CDSS used routinely in an orthopedic surgery department and integrated into the hospital information system changed physician behavior and improved compliance with guidelines.

Author Affiliations: Department of Public Health, Faculté de Médecine Broussais Hôtel Dieu (Dr Durieux), Department of Orthopedics, Lariboisière Hospital, Assistance Publique–Hôpitaux de Paris (Dr Nizard), Epidemiology Unit, Bichat Hospital, Assistance Publique–Hôpitaux de Paris (Dr Ravaud), Paris, France; and the Department of Biostatistics and Medical Informatics, Henri Mondor Hospital, Assistance Publique–Hôpitaux de Paris, Créteil, France (Drs Mounier and Lepage).

RELATED ARTICLE

June 7, 2000
JAMA. 2000;283(21):2861-2862.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Impact of Electronic Alerts on Isolation Precautions for Patients With Multidrug-Resistant Bacteria
Kac et al.
Arch Intern Med 2007;167:2086-2090.
ABSTRACT | FULL TEXT  

Intervention targeted at nurses to improve venous thromboprophylaxis
Labarere et al.
Int J Qual Health Care 2007;19:301-308.
ABSTRACT | FULL TEXT  

Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: FINDINGS FROM THE GLOBAL ORTHOPAEDIC REGISTRY
Warwick et al.
J Bone Joint Surg Br 2007;89-B:799-807.
ABSTRACT | FULL TEXT  

Hospitals' compliance with prophylaxis guidelines for venous thromboembolism
Yu et al.
Am J Health Syst Pharm 2007;64:69-76.
ABSTRACT | FULL TEXT  

Patient ethnicity and use of venous thromboembolism prophylaxis
Gelber and Seto
Int J Qual Health Care 2006;18:23-29.
ABSTRACT | FULL TEXT  

Health Information Technology and Physician-Patient Interactions: Impact of Computers on Communication during Outpatient Primary Care Visits
Hsu et al.
J. Am. Med. Inform. Assoc. 2005;12:474-480.
ABSTRACT | FULL TEXT  

Electronic Alerts to Prevent Venous Thromboembolism among Hospitalized Patients
Kucher et al.
NEJM 2005;352:969-977.
ABSTRACT | FULL TEXT  

Specialist Nurse-Led Clinics to Improve Control of Hypertension and Hyperlipidemia in Diabetes: Economic analysis of the SPLINT trial
Mason et al.
Diabetes Care 2005;28:40-46.
ABSTRACT | FULL TEXT  

A systematic review of computer-based patient record systems and quality of care: more randomized clinical trials or a broader approach?
Delpierre et al.
Int J Qual Health Care 2004;16:407-416.
ABSTRACT | FULL TEXT  

Impact of Prescribing Guidelines for Inpatient Anticoagulation
Schumock et al.
The Annals of Pharmacotherapy 2004;38:1570-1575.
ABSTRACT | FULL TEXT  

Antithrombotic and Thrombolytic Therapy: From Evidence to Application: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Schunemann et al.
Chest 2004;126:688S-696S.
ABSTRACT | FULL TEXT  

Computerized Reminders Reduce the Use of Medications during Shortages
Bogucki et al.
J. Am. Med. Inform. Assoc. 2004;11:278-280.
ABSTRACT | FULL TEXT  

Pulmonary Embolism After Coronary Artery Bypass Grafting
Goldhaber and Schoepf
Circulation 2004;109:2712-2715.
FULL TEXT  

Acute Pulmonary Embolism: Part II: Risk Stratification, Treatment, and Prevention
Goldhaber and Elliott
Circulation 2003;108:2834-2838.
FULL TEXT  

Prevention of Venous Thromboembolism in the ICU
Geerts and Selby
Chest 2003;124:357S-363S.
ABSTRACT | FULL TEXT  

Value for money of changing healthcare services? Economic evaluation of quality improvement
Severens
Qual Saf Health Care 2003;12:366-371.
ABSTRACT | FULL TEXT  

Integrating Medical Informatics and Health Services Research: The Need for Dual Training at the Clinical Health Systems and Policy Levels
Mandl and Lee
J. Am. Med. Inform. Assoc. 2002;9:127-132.
ABSTRACT | FULL TEXT  

When Is It Cost-effective to Change the Behavior of Health Professionals?
Mason et al.
JAMA 2001;286:2988-2992.
ABSTRACT | FULL TEXT  

Evidence-Based Medicine in Anesthesiology
Pronovost et al.
Anesth. Analg. 2001;92:787-794.
FULL TEXT  

A Randomized Controlled Trial of Point-of-Care Evidence to Improve the Antibiotic Prescribing Practices for Otitis Media in Children
Christakis et al.
Pediatrics 2001;107:15e-15.
ABSTRACT | FULL TEXT  

Prevention of Venous Thromboembolism
Geerts et al.
Chest 2001;119:132S-175S.
FULL TEXT