A clinical decision support system for prevention of venous thromboembolism - Effect on physician behavior

Context Computer-based clinical decision support systems (CDSSs) have been promoted for their potential to improve quality of health care. However, gi ven the limited range of clinical settings in which they have been tested, such systems must be evaluated rigorously before widespread introduction in to clinical practice. Objective To determine whether presentation of venous thromboembolism proph ylaxis guidelines using a CDSS increases the proportion of appropriate clin ical practice decisions made. Design Time-series study conducted between December 1997 and July 1999. Setting Orthopedic surgery department of a teaching hospital in Paris, Fran ce. Participants A total of 1971 patients who underwent orthopedic surgery. Intervention A CDSS designed to provide immediate information pertaining to venous thromboembolism prevention among surgical patients was integrated i nto daily medical practice during three 10-week intervention periods, alter nated with four 10-week control periods, with a 4-week washout between each period. Main Outcome Measure Proportion of appropriate prescriptions ordered for an ticoagulation, according to preestablished clinical guidelines, during inte rvention vs control periods. Results Physicians complied with guidelines in 82.8% (95% confidence interv al [CI], 77.6%-87.1%) of cases during control periods and in 94.9% (95% CI, 92.5%-96.6%) of cases during intervention periods. During each interventio n period, the appropriateness of prescription increased significantly (P<.0 01). Each time the CDSS was removed, physician practice reverted to that ob served before initiation of the intervention. The relative risk of inapprop riate practice decisions during control periods vs intervention periods was 3.8 (95% CI, 2.7-5.4). Conclusions In our study, implementation of clinical guidelines for venous thromboembolism prophylaxis through a CDSS used routinely in an orthopedic surgery department and integrated into the hospital information system chan ged physician behavior and improved compliance with guidelines.