Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?

Abstract

Objective: Physicians typically respond to roughly half of the clinical decision support prompts they receive. This study was designed to test the hypothesis that selectively highlighting prompts in yellow would improve physicians' responsiveness.

Methods: We conducted a randomized controlled trial using the Child Health Improvement Through Computer Automation clinical decision support system in 4 urban primary care pediatric clinics. Half of a set of electronic prompts of interest was highlighted in yellow when presented to physicians in 2 clinics. The other half of the prompts was highlighted when presented to physicians in the other 2 clinics. Analyses compared physician responsiveness to the 2 randomized sets of prompts: highlighted versus not highlighted. Additionally, several prompts deemed high priority were highlighted during the entire study period in all clinics. Physician response rates to the high-priority highlighted prompts were compared to response rates for those prompts from the year before the study period, when they were not highlighted.

Results: Physicians did not respond to prompts that were highlighted at higher rates than prompts that were not highlighted (62% and 61%, respectively; odds ratio 1.056, P = .259, NS). Similarly, physicians were no more likely to respond to high-priority prompts that were highlighted compared to the year before, when the prompts were not highlighted (59% and 59%, respectively, χ(2) = 0.067, P = .796, NS).

Conclusions: Highlighting reminder prompts did not increase physicians' responsiveness. We provide possible explanations why highlighting did not improve responsiveness and offer alternative strategies to increasing physician responsiveness to prompts.

Keywords: alert fatigue; clinical decision support; pediatric; prompts; reminders.

Figure 1

Example of yellow highlighted prompt seen by physician on Physician Worksheet (PWS).

Figure 2

Proportions of physicians’ responses to prompts as a function of whether they were color higlighted. (Data from prompts not presented to physicians at least 15 times total during the study period have been omitted from this graph.) *Indicates statistical significance accounting for Bonferonni Correction (0.05/8 = 0.00625).