Evidence map›Paper›PMID 36018731›Full record

Trial reportJournal of the American Medical Informatics Association : JAMIA2022

Interruptive Electronic Alerts for Choosing Wisely Recommendations: A Cluster Randomized Controlled Trial.

Vy T Ho, Rachael C Aikens, Geoffrey Tso, Paul A Heidenreich, Christopher Sharp, Steven M Asch, Jonathan H Chen, Neil K Shah

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

Trial report in Journal of the American Medical Informatics Association : JAMIA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02709772 (Provider Alerts to Reduce Unnecessary Care), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–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.

NCT02709772 nacompletednot on this map

Provider Alerts to Reduce Unnecessary Care

TypeinterventionalSponsorStanford UniversityRan2016 to 2018Enrolled50ConditionsPhysician's RoleArmsElectronic Record Alert
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Article
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

8 authors.

Vy T HoDivision of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.ORCID 0000-0002-5570-0536
Rachael C AikensDepartment of Biomedical Informatics, Stanford University School of Medicine, Stanford, California, USA.
Geoffrey TsoDivision of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California, USA.
Paul A HeidenreichDivision of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Christopher SharpDepartment of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Steven M AschDivision of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California, USA.
Jonathan H ChenStanford Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California, USA.
Neil K ShahDepartment of Pathology, Stanford University School of Medicine, Stanford, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the efficacy of interruptive electronic alerts in improving adherence to the American Board of Internal Medicine's Choosing Wisely recommendations to reduce unnecessary laboratory testing. MATERIALS AND

methodsWe administered 5 cluster randomized controlled trials simultaneously, using electronic medical record alerts regarding prostate-specific antigen (PSA) testing, acute sinusitis treatment, vitamin D testing, carotid artery ultrasound screening, and human papillomavirus testing. For each alert, we assigned 5 outpatient clinics to an interruptive alert and 5 were observed as a control. Primary and secondary outcomes were the number of postalert orders per 100 patients at each clinic and number of triggered alerts divided by orders, respectively. Post hoc analysis evaluated whether physicians experiencing interruptive alerts reduced their alert-triggering behaviors.

resultsMedian postalert orders per 100 patients did not differ significantly between treatment and control groups; absolute median differences ranging from 0.04 to 0.40 for PSA testing. Median alerts per 100 orders did not differ significantly between treatment and control groups; absolute median differences ranged from 0.004 to 0.03. In post hoc analysis, providers receiving alerts regarding PSA testing in men were significantly less likely to trigger additional PSA alerts than those in the control sites (Incidence Rate Ratio 0.12, 95% CI [0.03-0.52]). DISCUSSION: Interruptive point-of-care alerts did not yield detectable changes in the overall rate of undesired orders or the order-to-alert ratio between active and silent sites. Complementary behavioral or educational interventions are likely needed to improve efforts to curb medical overuse.

conclusionImplementation of interruptive alerts at the time of ordering was not associated with improved adherence to 5 Choosing Wisely guidelines.

trial registrationNCT02709772.

Indexed as

Decision Support Systems, ClinicalMedical Order Entry SystemsElectronic Health RecordsElectronicsHumansMaleProstate-Specific AntigenVitamin DProstate-Specific AntigenVitamin DChoosing Wiselyclinical decision supportinterruptive alertsrandomized controlled trial

Identifiers

PMID36018731
PMCPMC10161518

What OpenQuestion holds

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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.