Trial reportAnnals of family medicine
Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDs: a randomized controlled trial.
Trial report in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00691171 (Using an Electronic Health Record-based Intervention and Broad Education Reach Strategies to Improve Quality of Care for GERD and Gastroprotection for Patients on NSAIDs), which is not on this map. Cited by 28 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Using an Electronic Health Record-based Intervention and Broad Education Reach Strategies to Improve Quality of Care for GERD and Gastroprotection for Patients on NSAIDs: a Randomized Controlled Trial
Who cites it
28 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Digital patient safety interventions in primary care: a systematic review and meta-analysis.BMC medicine · 2026Pooled it
- Digital tracking, provider decision support systems, and targeted client communication via mobile devices to improve primary health care.The Cochrane database of systematic reviews · 2025Pooled it
- Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care: A Systematic Review.JAMA network open · 2024Pooled it
- Decision-support tools via mobile devices to improve quality of care in primary healthcare settings.The Cochrane database of systematic reviews · 2021Pooled it
- The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis.BMC medical informatics and decision making · 2021Pooled it
- Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials.BMJ (Clinical research ed.) · 2020Pooled it
- The effects of on-screen, point of care computer reminders on processes and outcomes of care.The Cochrane database of systematic reviews · 2009Pooled it
- An Electronic Health Record-based Intervention to Promote Hepatitis C Virus Testing Among Adults Born Between 1945 and 1965: A Cluster-randomized Trial.Medical care · 2017Trial
- Typical electronic health record use in primary care practices and the quality of diabetes care.Annals of family medicineTrial
- Article
- The role of electronic health records systems in de-implementing low-value care in primary care: a scoping review.Implementation science communications · 2025Review
- Analyzing the impact of pharmacogenomics-guided nonsteroidal anti-inflammatory drug alerts in clinical practice.JAMIA open · 2025Article
- Impact of pharmacist-evaluated clinical decision support system alerts on potentially missing or inappropriately prescribed proton pump inhibitors at hospital discharge: a retrospective cross-sectional study.International journal of clinical pharmacy · 2024Article
- Feasibility and acceptability of patient- and clinician-level antithrombotic stewardship interventions to reduce gastrointestinal bleeding risk in patients using warfarin (Anticoagulation with Enhanced Gastrointestinal Safety): a factorial randomized controlled pilot trial.Research and practice in thrombosis and haemostasis · 2024Article
- Development of a multicomponent implementation strategy to reduce upper gastrointestinal bleeding risk in patients using warfarin and antiplatelet therapy, and protocol for a pragmatic multilevel randomized factorial pilot implementation trial.Implementation science communications · 2022Article
- Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia.PloS one · 2022Article
- Creation and implementation of an electronic health record note for quality improvement in pediatric epilepsy: Practical considerations and lessons learned.Epilepsia open · 2021Article
- Electronic Medical Record-Based Case Phenotyping for the Charlson Conditions: Scoping Review.JMIR medical informatics · 2021Article
- Integration of physical abuse clinical decision support at 2 general emergency departments.Journal of the American Medical Informatics Association : JAMIA · 2019Article
- Development of an electronic medical record-based child physical abuse alert system.Journal of the American Medical Informatics Association : JAMIA · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeElectronic health records (EHRs) with clinical decision support hold promise for improving quality of care, but their impact on management of chronic conditions has been mixed. This study examined the impact of EHR-based clinical decision support on adherence to guidelines for reducing gastrointestinal complications in primary care patients on nonsteroidal anti-inflammatory drugs (NSAIDs).
methodsThis randomized controlled trial was conducted in a national network of primary care offices using an EHR and focused on patients taking traditional NSAIDs who had factors associated with a high risk for gastrointestinal complications (a history of peptic ulcer disease; concomitant use of anticoagulants, anti-platelet medications [including aspirin], or corticosteroids; or an age of 75 years or older). The offices were randomized to receive EHR-based guidelines and alerts for high-risk patients on NSAIDs, or usual care. The primary outcome was the proportion of patients who received guideline-concordant care during the 1-year study period (June 2007-June 2008), defined as having their traditional NSAID discontinued (including a switch to a lower-risk medication), having a gastroprotective medication coprescribed, or both.
resultsParticipants included 27 offices with 119 clinicians and 5,234 high-risk patients. Intervention patients were more likely than usual care patients to receive guideline-concordant care (25.4% vs 22.4%, adjusted odds ratio = 1.19; 95% confidence interval, 1.01-1.42). For individual high-risk groups, patients on low-dose aspirin were more likely to receive guideline-concordant care with the intervention vs usual care (25.0% vs 20.8%, adjusted odds ratio = 1.30; 95% confidence interval, 1.04-1.62), but there was no significant difference for patients in other high-risk groups.
conclusionsThis study showed only a small impact of EHR-based clinical decision support for high-risk patients on NSAIDs in primary care offices. These results add to the growing literature about the complexity of EHR-based clinical decision support for improving quality of care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.