Evidence map›Paper›PMID 26471846›Full record

ArticleBMC nephrology2015

Clinical decision support improves physician guideline adherence for laboratory monitoring of chronic kidney disease: a matched cohort study.

Jennifer Ennis, Daniel Gillen, Arthur Rubenstein, Elaine Worcester, Mark E Brecher, John Asplin, Fredric Coe

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In one paragraph

Article in BMC nephrology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  4. Impact and Feasibility of Personalized Decision Support for Older Patients with Diabetes: A Pilot Randomized Trial.Medical decision making : an international journal of the Society for Medical Decision Making · 2017
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jennifer EnnisLitholink Corporation®, A LabCorp Company, Chicago, IL, USA. ennisj1@labcorp.com.
Daniel GillenUniversity of California at Irvine, Irvine, CA, USA. dgillen@uci.edu.
Arthur RubensteinUniversity of Pennsylvania, Philadelphia, PA, USA. ahr@exchange.upenn.edu.
Elaine WorcesterUniversity of Chicago, Chicago, IL, USA. eworcest@medicine.bsd.uchicago.edu.
Mark E BrecherLaboratory Corporation of America® Holdings, Burlington, NC, USA. brechem@labcorp.com.
John AsplinLitholink Corporation®, A LabCorp Company, Chicago, IL, USA. asplinj@labcorp.com.
Fredric CoeUniversity of Chicago, Chicago, IL, USA. fcoe@medicine.bsd.uchicago.edu.

Funding

Re-Engineering Translational Research at the University of ChicagoUL1TR000430 · NCATS · UNIVERSITY OF CHICAGO · PI SOLWAY, JULIAN · 2012 to 2016
$20.2M
NCATS NIH HHS UL1 TR000430
6 · The paper itself

Abstract

backgroundGuidelines exist for chronic kidney disease (CKD) but are not well implemented in clinical practice. We evaluated the impact of a guideline-based clinical decision support system (CDSS) on laboratory monitoring and achievement of laboratory targets in stage 3-4 CKD patients.

methodsWe performed a matched cohort study of 12,353 stage 3-4 CKD patients whose physicians opted to receive an automated guideline-based CDSS with CKD-related lab results, and 42,996 matched controls whose physicians did not receive the CDSS. Physicians were from US community-based physician practices utilizing a large, commercial laboratory (LabCorp®). We compared the percentage of laboratory tests obtained within guideline-recommended intervals and the percentage of results within guideline target ranges between CDSS and non-CDSS patients. Laboratory tests analyzed included estimated glomerular filtration rate, plasma parathyroid hormone, serum calcium, phosphorus, 25-hydroxy vitamin D (25-D), total carbon dioxide, transferrin saturation (TSAT), LDL cholesterol (LDL-C), blood hemoglobin, and urine protein measurements.

resultsPhysicians who used the CDSS ordered all CKD-relevant testing more in accord with guidelines than those who did not use the system. Odds ratios favoring CDSS ranged from 1.29 (TSAT) to 1.88 (serum phosphorus) [CI, 1.20 to 2.01], p < 0.001 for all tests. The CDSS impact was greater for primary care physicians versus nephrologists. CDSS physicians met guideline targets for LDL-C and 25-D more often, but hemoglobin targets less often, than non-CDSS physicians. Use of CDSS did not impact guideline target achievement for the remaining tests.

conclusionsUse of an automated laboratory-based CDSS may improve physician adherence to guidelines with respect to timely monitoring of CKD.

Indexed as

Decision Support Systems, ClinicalAgedAged, 80 and overCalciumCarbon DioxideCase-Control StudiesCholesterol, LDLFemaleGlomerular Filtration RateGuideline AdherenceHemoglobinsHumansKidney Function TestsMaleMiddle AgedNephrology25-hydroxyvitamin DCalciumCarbon DioxideCholesterol, LDLHemoglobinsParathyroid HormonePhosphorusTransferrinsVitamin D

Identifiers

PMID26471846
PMCPMC4608162

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Registered trials

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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.