Enhanced clinical decision-support alerts improve HIV outcomes

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Interactive alerts from a clinical decision-support (CDS) system improved care and outcomes for HIV patients more than static alerts, according to a study published in the Annals of Internal Medicine.

Researchers from Boston's Massachusetts General Hospital looked at the 1,011 patients, divided between the two types of alerts at a large outpatient clinic. The 33 doctors were not aware of into which group the patients were assigned. 

Based on automated nightly check of hospital databases, the CDS system generated alerts for virologic failure, evidence of suboptimal followup, and 11 abnormal laboratory results.

The researchers compared alerts that appeared only on the patient's electronic medical records page (control group) with a new type of alert that appeared on the provider's home page and in biweekly emails. The new alert included hyperlinks to previous labs, appointment histories and other previous alerts, MedPage Today reported.

Researchers primarily measured the count of CD4-positive T cells during the year-long study. They found significant improvement of 5.3 cells per cubic millimeter of blood among patients in the intervention group, compared with 3.2 for patients in the control group.

Three rules on missed appointments were created, as well as a category of "high-risk" patients who had a history of skipping appointments.

After a suboptimal follow-up alert, the intervention group's next appointment was scheduled in 1.71 months, compared with 3.48 months for the control patients. No difference was found in the rate of virologic failure.

More than 90 percent of participating providers supported making the new alerts part of the clinic's standard care, according to MedPage Today.

Though previous research has shown that text messaging can improve HIV medication compliance and reduce medication errors by using EHRs, the Boston researchers said they wanted to address the lack of evidence that CDS systems, in particular, improve outcomes for HIV patients.

CDS systems topped hospital leaders IT wish lists for the next year in a Black Book Rankings survey. They provide the best return on investment among EHR functions, according to research in the American Journal of Managed Care.

Rand Corp. research called for improvement of CDS systems, however, to better align research with clinical practice.

To learn more:
- read the abstract
- here's the MedPage Today article

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