ArticleApplied clinical informatics2019
CDS in a Learning Health Care System: Identifying Physicians' Reasons for Rejection of Best-Practice Recommendations in Pneumonia through Computerized Clinical Decision Support.
Article in Applied clinical informatics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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The trial behind it
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Who cites it
21 citing papers in PubMed.
- User Actions within a Clinical Decision Support Alert for the Management of Hypertension in Chronic Kidney Disease.Applied clinical informatics · 2025Trial
- Evaluation of an Antimicrobial Stewardship Decision Support for Pediatric Infections.Applied clinical informatics · 2023Trial
- A Pragmatic, Stepped-Wedge, Cluster-controlled Clinical Trial of Real-Time Pneumonia Clinical Decision Support.American journal of respiratory and critical care medicine · 2022Trial
- User-Centered Redesign of a Clinical Decision Support System for Pneumonia in the Emergency Department.Applied clinical informatics · 2026Article
- Evaluation of the Use of a Novel Intelligent Diagnosis and Cost Control System on Pediatric Bronchopneumonia Outcomes: Retrospective Cohort Study.JMIR pediatrics and parenting · 2025Article
- Endocarditis prophylaxis in children and adolescents: indications in consideration of the dental treatment setting.European journal of pediatrics · 2025Article
- A systematic review of clinicians' acceptance and use of clinical decision support systems over time.NPJ digital medicine · 2025Article
- Clinical Decision Support to Reduce Hospital Length-of-Stay for Cancer Patients with Fever and Neutropenia.Applied clinical informatics · 2025Article
- The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support.BMC medical informatics and decision making · 2024Article
- Effects of a Pharmacist-Designed Clinical Decision Support System on Antimicrobial Stewardship.Applied clinical informatics · 2024Article
- Learning health systems on the front lines to strengthen care against future pandemics and climate change: a rapid review.BMC health services research · 2024Review
- Investigating Why Clinicians Deviate from Standards of Care: Liberating Patients from Mechanical Ventilation in the ICU.Proceedings of the SIGCHI conference on human factors in computing systems. CHI Conference · 2024Article
- Real-Time User Feedback to Support Clinical Decision Support System Improvement.Applied clinical informatics · 2022Article
- The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing.BMC medical informatics and decision making · 2022Article
- The Science of Learning Health Systems: Scoping Review of Empirical Research.JMIR medical informatics · 2022Article
- Deploying an Electronic Clinical Decision Support Tool for Diagnosis and Treatment of Pneumonia Into Rural and Critical Access Hospitals: Utilization, Effect on Processes of Care, and Clinician Satisfaction.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2022Article
- Development and Internal Validation of a Prediction Model to Risk Stratify Children With Suspected Community-Acquired Pneumonia.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Towards a Maturity Model for Clinical Decision Support Operations.Applied clinical informatics · 2019Article
- Clinical Decision Support Systems and Their Role in Antibiotic Stewardship: a Systematic Review.Current infectious disease reports · 2019Article
- Physicians Voluntarily Using an EHR-Based CDS Tool Improved Patients' Guideline-Related Statin Prescription Rates: A Retrospective Cohort Study.Applied clinical informatics · 2019Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundLocal implementation of guidelines for pneumonia care is strongly recommended, but the context of care that affects implementation is poorly understood. In a learning health care system, computerized clinical decision support (CDS) provides an opportunity to both improve and track practice, providing insights into the implementation process.
objectivesThis article examines physician interactions with a CDS to identify reasons for rejection of guideline recommendations.
methodsWe implemented a multicenter bedside CDS for the emergency department management of pneumonia that integrated patient data with guideline-based recommendations. We examined the frequency of adoption versus rejection of recommendations for site-of-care and antibiotic selection. We analyzed free-text responses provided by physicians explaining their clinical reasoning for rejection, using concept mapping and thematic analysis.
resultsAmong 1,722 patient episodes, physicians rejected recommendations to send a patient home in 24%, leaving text in 53%; reasons for rejection of the recommendations included additional or alternative diagnoses beyond pneumonia, and comorbidities or signs of physiologic derangement contributing to risk of outpatient failure that were not processed by the CDS. Physicians rejected broad-spectrum antibiotic recommendations in 10%, leaving text in 76%; differences in pathogen risk assessment, additional patient information, concern about antibiotic properties, and admitting physician preferences were given as reasons for rejection.
conclusionWhile adoption of CDS recommendations for pneumonia was high, physicians rejecting recommendations frequently provided feedback, reporting alternative diagnoses, additional individual patient characteristics, and provider preferences as major reasons for rejection. CDS that collects user feedback is feasible and can contribute to a learning health system.
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