Comparative effectiveness of generic commercial versus locally customized clinical decision support tools to reduce prescription of nonsteroidal anti-inflammatory drugs for patients with heart failure

Courtney Shakowski; Robert L Page Ii; Garth Wright; Cali Lunowa; Clyde Marquez; Krithika Suresh; Larry A Allen; Russel E Glasgow; Chen-Tan Lin; Abraham Wick; Katy E Trinkley

doi:10.1093/jamia/ocad109

Comparative effectiveness of generic commercial versus locally customized clinical decision support tools to reduce prescription of nonsteroidal anti-inflammatory drugs for patients with heart failure

J Am Med Inform Assoc. 2023 Aug 18;30(9):1516-1525. doi: 10.1093/jamia/ocad109.

Authors

Courtney Shakowski¹, Robert L Page Ii², Garth Wright², Cali Lunowa², Clyde Marquez², Krithika Suresh^{3

4}, Larry A Allen^{3

5}, Russel E Glasgow^{3

6}, Chen-Tan Lin^{1

7}, Abraham Wick¹, Katy E Trinkley^{1

2

3

6}

Affiliations

¹ UCHealth, Aurora, Colorado, USA.
² Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
³ Adult and Child Center for Outcomes Research and Delivery Science Center, Aurora, Colorado, USA.
⁴ Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA.
⁵ Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁶ Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁷ Division of Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

PMID: 37352404
PMCID: PMC10436140 (available on 2024-06-23)
DOI: 10.1093/jamia/ocad109

Abstract

Objective: To compare the effectiveness of 2 clinical decision support (CDS) tools to avoid prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with heart failure (HF): a "commercial" and a locally "customized" alert.

Methods: We conducted a retrospective cohort study of 2 CDS tools implemented within a large integrated health system. The commercial CDS tool was designed according to third-party drug content and EHR vendor specifications. The customized CDS tool underwent a user-centered design process informed by implementation science principles, with input from a cross disciplinary team. The customized CDS tool replaced the commercial CDS tool. Data were collected from the electronic health record via analytic reports and manual chart review. The primary outcome was effectiveness, defined as whether the clinician changed their behavior and did not prescribe an NSAID.

Results: A random sample of 366 alerts (183 per CDS tool) was evaluated that represented 355 unique patients. The commercial CDS tool was effective for 7 of 172 (4%) patients, while the customized CDS tool was effective for 81 of 183 (44%) patients. After adjusting for age, chronic kidney disease, ejection fraction, NYHA class, concurrent prescription of an opioid or acetaminophen, visit type (inpatient or outpatient), and clinician specialty, the customized alerts were at 24.3 times greater odds of effectiveness compared to the commercial alerts (OR: 24.3 CI: 10.20-58.06).

Conclusion: Investing additional resources to customize a CDS tool resulted in a CDS tool that was more effective at reducing the total number of NSAID orders placed for patients with HF compared to a commercially available CDS tool.

Keywords: alert fatigue; clinical decision support; drug alerts; heart failure; implementation science; nonsteroidal anti-inflammatory drugs.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Decision Support Systems, Clinical*
Heart Failure* / drug therapy
Humans
Prescriptions
Retrospective Studies

Substances

Anti-Inflammatory Agents, Non-Steroidal

Abstract

Publication types

MeSH terms

Substances

Grants and funding