Trial reportImplementation science : IS2011
Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care.
Trial report in Implementation science : IS, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01386047 (Evidence Based Decision Making), which is not on this map. Cited by 32 papers, 3 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.
Evidence Based Decision Making: Integrating Clinical Prediction Rules Into Electronic Health Records
Who cites it
32 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis.Journal of the American Medical Informatics Association : JAMIA · 2018Pooled it
- An appraisal of published usability evaluations of electronic health records via systematic review.Journal of the American Medical Informatics Association : JAMIA · 2017Pooled it
- Effects of computer-aided clinical decision support systems in improving antibiotic prescribing by primary care providers: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2015Pooled it
- Integration of physical abuse clinical decision support into the electronic health record at a Tertiary Care Children's Hospital.Journal of the American Medical Informatics Association : JAMIA · 2018Trial
- Measures of user experience in a streptococcal pharyngitis and pneumonia clinical decision support tools.Applied clinical informatics · 2014Trial
- Barriers and Enablers for Sustaining Nurse-Led Use of Clinical Decision Support Tools for Antibiotic Stewardship: Qualitative Study.JMIR nursing · 2026Article
- Nursing Performance Using Clinical Prediction Rules for Acute Respiratory Infection Management: A Case-Based Simulation.Applied clinical informatics · 2025Article
- Usability of a Human Factors-based Clinical Decision Support in the Emergency Department: Lessons Learned for Design and Implementation.Human factors · 2024Article
- Retrospective analysis of the human-centered design process used to develop a clinical decision support in the emergency department: PE Dx Study Part 2.Human factors in healthcare · 2023Article
- Integrating Clinical Decision Support Into Electronic Health Record Systems Using a Novel Platform (EvidencePoint): Developmental Study.JMIR formative research · 2023Article
- Workflow integration analysis of a human factors-based clinical decision support in the emergency department.Applied ergonomics · 2021Article
- Contemporary use of real-world data for clinical trial conduct in the United States: a scoping review.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Investigation of a Mobile Health Texting Tool for Embedding Patient-Reported Data Into Diabetes Management (i-Matter): Development and Usability Study.JMIR formative research · 2020Article
- Developing a framework for evidence-based grading and assessment of predictive tools for clinical decision support.BMC medical informatics and decision making · 2019Review
- User-Centered Development of a Behavioral Economics Inspired Electronic Health Record Clinical Decision Support Module.Studies in health technology and informatics · 2019Article
- Designing for implementation: user-centered development and pilot testing of a behavioral economic-inspired electronic health record clinical decision support module.Pilot and feasibility studies · 2019Article
- THE HIGH COST OF LOW VALUE CARE.Transactions of the American Clinical and Climatological Association · 2019Article
- Translating clinical trial results into personalized recommendations by considering multiple outcomes and subjective views.NPJ digital medicine · 2019Article
- Innovating From Within: A Process Model for User-Centered Digital Development in Academic Medical Centers.JMIR human factors · 2018Article
- Bridging the Gap Between Academic Research and Pragmatic Needs in Usability: A Hybrid Approach to Usability Evaluation of Health Care Information Systems.JMIR human factors · 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
10 authors.
Funding
Abstract
backgroundClinical prediction rules (CPRs) represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR) has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR) trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting.
methodsA multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS) tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149) were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated) groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters) and chest x-rays (pneumonia iCPR only) between intervention and control providers. DISCUSSION: Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative process will lead to higher rates of utilization and EBM guided use of antibiotics and chest x-ray's in primary care.
trial registrationClinicalTrials.gov Identifier NCT01386047.
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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.