Evidence map›Paper›PMID 33148311›Full record

Trial reportImplementation science : IS2020

Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial.

Nicolas Delvaux, Veerle Piessens, Tine De Burghgraeve, Pavlos Mamouris, Bert Vaes, Robert Vander Stichele, Hanne Cloetens, Josse Thomas, Dirk Ramaekers, An De Sutter and 1 more

Registry-linked trialAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02950142 (The Effect of Evidence-based Order Sets Within a CPOE System on the Quantity and Quality of Laboratory Test Ordering in Family Practice), which is not on this map. Cited by 18 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 4 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.

NCT02950142 nacompletednot on this map

The Effect of Evidence-based Order Sets Within a CPOE System on the Quantity and Quality of Laboratory Test Ordering in Family Practice: a Cluster Randomised Trial

TypeinterventionalSponsorUniversitaire Ziekenhuizen KU LeuvenRan2017 to 2019Enrolled288ConditionsDiabetes Mellitus, Hypertension, Cardiovascular Diseases, FatigueArmsCPOE with order sets for lab testing, CPOE without order sets for lab testing
3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
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  16. Laboratory Demand Management Strategies-An Overview.Diagnostics (Basel, Switzerland) · 2021
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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

11 authors.

Nicolas DelvauxDepartment of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium. nicolas.delvaux@kuleuven.be.ORCID 0000-0002-7335-4075
Veerle PiessensDepartment of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
Tine De BurghgraeveDepartment of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium.
Pavlos MamourisDepartment of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium.
Bert VaesDepartment of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium.
Robert Vander SticheleDepartment of Basic and Applied Medical Sciences, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
Hanne CloetensCenter for General Practice, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610, Wilrijk, Belgium.
Josse ThomasPharmaCS, Merchtem, Belgium.
Dirk RamaekersDepartment of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium.
An De SutterDepartment of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
Bert AertgeertsDepartment of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundInappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care.

methodsThis study was a pragmatic, cluster randomized, open-label, controlled clinical trial.

settingTwo hundred eighty general practitioners (GPs) from 72 primary care practices in Belgium. PATIENTS: Patients aged ≥ 18 years with a laboratory test order for at least one of 17 indications: cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication.

interventionsThe CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician. MEASUREMENTS: The primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume, and cascade activities.

resultsCDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16-0.26, p < 0.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37-10.93, p = 0.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease-0.05% increase) in possible diagnostic error.

conclusionsA CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error.

trial registrationClinicalTrials.gov Identifier: NCT02950142 , registered on October 25, 2016.

Indexed as

Clinical Laboratory TechniquesDecision Support Systems, ClinicalPrimary Health CareDiagnostic ErrorsHumans

Identifiers

PMID33148311
PMCPMC7640389

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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.