Observational studyThe American journal of managed care2018
Choosing Wisely clinical decision support adherence and associated inpatient outcomes.
Observational study in The American journal of managed care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
What it found
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed.
- Exploring primary care providers' perspectives on clinical decision support for venous thromboembolism diagnosis: a qualitative study.BMJ open · 2026Article
- The Value of Clinical Decision Support in Healthcare: A Focus on Screening and Early Detection.Diagnostics (Basel, Switzerland) · 2025Review
- Evaluating the Accuracy and Impact of the ESR-iGuide Decision Support Tool in Optimizing CT Imaging Referral Appropriateness.Journal of imaging informatics in medicine · 2025Article
- Anomaly-based threat detection in smart health using machine learning.BMC medical informatics and decision making · 2024Article
- Article
- Inappropriate CT examinations: how much, who and where? Insights from a clinical decision support system (CDSS) analysis.European radiology · 2023Article
- Choosing Wisely in clinical practice: Embracing critical thinking, striving for safer care.Journal of internal medicine · 2022Review
- Electronic Health Records as Biased Tools or Tools Against Bias: A Conceptual Model.The Milbank quarterly · 2022Article
- Exploring emergency physicians' knowledge, attitudes, and behaviour towards Choosing Wisely in Taiwan.PloS one · 2022Article
- Impact of clinical decision support therapeutic interchanges on hospital discharge medication omissions and duplications.American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2021Article
- Impact of Individual, Organizational, and Technological Factors on the Implementation of an Online Portal to Support a Clinical Pathway Addressing Psycho-Oncology Care: Mixed Methods Study.JMIR human factors · 2021Article
- A thematic analysis to examine the feasibility of EHR-based clinical decision support for implementingJAMIA open · 2021Article
- Examining the Relationship between Cost and Quality of Care in the Neonatal Intensive Care Unit and Beyond.Children (Basel, Switzerland) · 2020Review
- Economic impact of clinical decision support interventions based on electronic health records.BMC health services research · 2020Review
- Trends in utilization of sentinel node biopsy and adjuvant radiation in women ≥ 70.The breast journal · 2020Article
- Measuring implementation feasibility of clinical decision support alerts for clinical practice recommendations.Journal of the American Medical Informatics Association : JAMIA · 2020Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesTo determine whether utilization of clinical decision support (CDS) is correlated with improved patient clinical and financial outcomes. STUDY
designObservational study of 26,424 patient encounters. In the treatment group, the provider adhered to all CDS recommendations. In the control group, the provider did not adhere to CDS recommendations.
methodsAn observational study of provider adherence to a CDS system was conducted using inpatient encounters spanning 3 years. Data comprised alert status (adherence), provider type (resident, attending), patient demographics, clinical outcomes, Medicare status, and diagnosis information. We assessed the associations between alert adherence and 4 outcome measures: encounter length of stay, odds of 30-day readmission, odds of complications of care, and total direct costs. The associations between alert adherence and the outcome measures were estimated using 4 generalized linear models that adjusted for potential confounders, such as illness severity and case complexity.
resultsThe total encounter cost increased 7.3% (95% CI, 3.5%-11%) for nonadherent encounters versus adherent encounters. We found a 6.2% (95% CI, 3.0%-9.4%) increase in length of stay for nonadherent versus adherent encounters. The odds ratio for readmission within 30 days increased by 1.14 (95% CI, 0.998-1.31) for nonadherent versus adherent encounters. The odds ratio for complications increased by 1.29 (95% CI, 1.04-1.61) for nonadherent versus adherent encounters.
conclusionsConsistent improvements in measured outcomes were seen in the treatment group versus the control group. We recommend that provider organizations consider the introduction of real-time CDS to support adherence to evidence-based guidelines, but because we cannot determine the cause of the associations between CDS interventions and improved clinical and financial outcomes, further study is required.
Indexed as
Identifiers
30130028PMC6813785What OpenQuestion holds
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.