Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2015 Jan;6(1):54-60.
doi: 10.1177/2150131914546325. Epub 2014 Aug 25.

Evaluation of the effect of decision support on the efficiency of primary care providers in the outpatient practice

Kavishwar B Wagholikar  1 , Ronald A Hankey  2 , Lindsay K Decker  2 , Stephen S Cha  2 , Robert A Greenes  3 , Hongfang Liu  2 , Rajeev Chaudhry  2
Affiliations
Free PMC article
Randomized Controlled Trial

Evaluation of the effect of decision support on the efficiency of primary care providers in the outpatient practice

Kavishwar B Wagholikar et al. J Prim Care Community Health. 2015 Jan.
Free PMC article

Abstract

Background: Clinical decision support (CDS) for primary care has been shown to improve delivery of preventive services. However, there is little evidence for efficiency of physicians due to CDS assistance. In this article, we report a pilot study for measuring the impact of CDS on the time spent by physicians for deciding on preventive services and chronic disease management.

Methods: We randomly selected 30 patients from a primary care practice, and assigned them to 10 physicians. The physicians were requested to perform chart review to decide on preventive services and chronic disease management for the assigned patients. The patients assignment was done in a randomized crossover design, such that each patient received 2 sets of recommendations-one from a physician with CDS assistance and the other from a different physician without CDS assistance. We compared the physician recommendations made using CDS assistance, with the recommendations made without CDS assistance.

Results: The physicians required an average of 1 minute 44 seconds, when they were they had access to the decision support system and 5 minutes when they were unassisted. Hence the CDS assistance resulted in an estimated saving of 3 minutes 16 seconds (65%) of the physicians' time, which was statistically significant (P < .0001). There was no statistically significant difference in the number of recommendations.

Conclusion: Our findings suggest that CDS assistance significantly reduced the time spent by physicians for deciding on preventive services and chronic disease management. The result needs to be confirmed by performing similar studies at other institutions.

Keywords: chronic diseases; clinical decision support systems; preventive health services; task performance and analysis; time motion study.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Crossover design of the study. Circles indicate patients, rectangles indicate physicians and connecting lines indicate the assignments. Each patient received 2 sets of recommendations—one from a physician with clinical decision support (CDS) assistance and the other from a different physician without CDS assistance. Each physician provided recommendations for half the assigned patients using CDS assistance, and made the recommendations without CDS assistance for the other half of the patients.
Figure 2.
Figure 2.
Time required to complete the checklist and number of recommendations per patient, for the assisted versus unassisted physicians.
See this image and copyright information in PMC

References

    1. Agency for Healthcare Research and Quality. 2011. National Healthcare Quality and Disparities Reports. 2012. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr11/qrdr11.html Accesed July 24, 2014.
    1. Pham HH, Schrag D, Hargraves JL, Bach PB. Delivery of preventive services to older adults by primary care physicians. JAMA. 2005;294:473-481. - PubMed
    1. Goodwin JS, Singh A, Reddy N, Riall TS, Kuo YF. Overuse of screening colonoscopy in the Medicare population. Arch Intern Med. 2011;171:1335-1343. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Cancer screening—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(3):41-45. - PubMed
    1. Centers for Disease Control and Prevention. Noninfluenza vaccination coverage among adults—United States, 2011. MMWR Morb Mortal Wkly Rep. 2013;62(4):66-72. - PMC - PubMed

Publication types

LinkOut - more resources