ArticleJMIR medical informatics2021
Applying Clinical Decision Support Design Best Practices With the Practical Robust Implementation and Sustainability Model Versus Reliance on Commercially Available Clinical Decision Support Tools: Randomized Controlled Trial.
Article in JMIR medical informatics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04028557 (Development and Validation of an Integrated Implementation Model for Clinical Decision Support for Heart Failure Prescribing), which is not on this map. Cited by 20 papers, 1 of them a synthesis 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.
Development and Validation of an Integrated Implementation Model for Clinical Decision Support for Heart Failure Prescribing
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Barriers and Facilitators to the Use of Clinical Decision Support Systems in Primary Care: A Mixed-Methods Systematic Review.Annals of family medicinePooled it
- A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: A randomized controlled trial.Journal of hospital medicine · 2023Trial
- Usability Testing of an Interoperable Computerized Clinical Decision Support Tool for Fall Risk Management in Primary Care.Applied clinical informatics · 2023Trial
- Optimizing Clinical Decision Support for Antibiotic Prescribing in Pediatric Acute Respiratory Tract Infections: A Usability Study.Applied clinical informatics · 2026Article
- Scalable and Privacy-Conscious End-to-End Processing of Large-Scale Clinical Data for Precision Medicine: Empirical Evaluation Study.JMIR medical informatics · 2026Article
- Collection of implementation-related data in pragmatic clinical trials: a cross-sectional study from the NIH Pragmatic Trials Collaboratory.Implementation science communications · 2026Article
- Aggregating Patient Safety and Status Information in the Electronic Health Record to Support Time-Sensitive Mobility Interventions in the Intensive Care Unit: Protocol for the Design and Testing of a Clinical Decision Support Tool.JMIR research protocols · 2025Article
- Automated Chronic Obstructive Pulmonary Disease Phenotyping and Control Assessment in Primary Care: Retrospective Multicenter Study Using the Seleida Model.JMIR medical informatics · 2025Article
- Pragmatic Integration of User-Centered Design and Implementation Science: A New Methodological Approach for Clinical Decision Support Implementation in EHRs.Applied clinical informatics · 2025Article
- Application of Nudges to Design Clinical Decision Support Tools: Systematic Approach Guided by Implementation Science.Journal of medical Internet research · 2025Article
- Implementing an Electronic Health Record-Integrated Pediatric Primary Care Sleep Screener.JAMA network open · 2025Observational
- Applying Implementation Science to Advance Electronic Health Record-Driven Learning Health Systems: Case Studies, Challenges, and Recommendations.Journal of medical Internet research · 2024Article
- Clinical Decision Support for Surgery: A Mixed Methods Study on Design and Implementation Perspectives From Urologists.Urology · 2024Article
- Implementation Science to Achieve Equity in Heart Failure Care: A Scientific Statement From the American Heart Association.Circulation · 2024Review
- The Application and Evolution of the Practical, Robust Implementation and Sustainability Model (PRISM): History and Innovations.Global implementation research and applications · 2024Article
- Sustained Effect of Clinical Decision Support for Heart Failure: A Natural Experiment Using Implementation Science.Applied clinical informatics · 2023Article
- Comparative effectiveness of generic commercial versus locally customized clinical decision support tools to reduce prescription of nonsteroidal anti-inflammatory drugs for patients with heart failure.Journal of the American Medical Informatics Association : JAMIA · 2023Article
- Design and pilot implementation for the BETTER CARE-HF trial: A pragmatic cluster-randomized controlled trial comparing two targeted approaches to ambulatory clinical decision support for cardiologists.American heart journal · 2023Article
- Research and Scholarly Methods: Implementation Science Studies.Journal of the American College of Clinical Pharmacy : JACCP · 2022Article
- An exploration of expectations and perceptions of practicing physicians on the implementation of computerized clinical decision support systems using a Qsort approach.BMC medical informatics and decision making · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundLimited consideration of clinical decision support (CDS) design best practices, such as a user-centered design, is often cited as a key barrier to CDS adoption and effectiveness. The application of CDS best practices is resource intensive; thus, institutions often rely on commercially available CDS tools that are created to meet the generalized needs of many institutions and are not user centered. Beyond resource availability, insufficient guidance on how to address key aspects of implementation, such as contextual factors, may also limit the application of CDS best practices. An implementation science (IS) framework could provide needed guidance and increase the reproducibility of CDS implementations.
objectiveThis study aims to compare the effectiveness of an enhanced CDS tool informed by CDS best practices and an IS framework with a generic, commercially available CDS tool.
methodsWe conducted an explanatory sequential mixed methods study. An IS-enhanced and commercial CDS alert were compared in a cluster randomized trial across 28 primary care clinics. Both alerts aimed to improve beta-blocker prescribing for heart failure. The enhanced alert was informed by CDS best practices and the Practical, Robust, Implementation, and Sustainability Model (PRISM) IS framework, whereas the commercial alert followed vendor-supplied specifications. Following PRISM, the enhanced alert was informed by iterative, multilevel stakeholder input and the dynamic interactions of the internal and external environment. Outcomes aligned with PRISM's evaluation measures, including patient reach, clinician adoption, and changes in prescribing behavior. Clinicians exposed to each alert were interviewed to identify design features that might influence adoption. The interviews were analyzed using a thematic approach.
resultsBetween March 15 and August 23, 2019, the enhanced alert fired for 61 patients (106 alerts, 87 clinicians) and the commercial alert fired for 26 patients (59 alerts, 31 clinicians). The adoption and effectiveness of the enhanced alert were significantly higher than those of the commercial alert (62% vs 29% alerts adopted, P<.001; 14% vs 0% changed prescribing, P=.006). Of the 21 clinicians interviewed, most stated that they preferred the enhanced alert.
conclusionsThe results of this study suggest that applying CDS best practices with an IS framework to create CDS tools improves implementation success compared with a commercially available tool.
trial registrationClinicalTrials.gov NCT04028557; http://clinicaltrials.gov/ct2/show/NCT04028557.
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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.