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Impact of electronic clinical decision support on adherence to guideline-recommended treatment for hyperlipidaemia, atrial fibrillation and heart failure: protocol for a cluster randomised trial
  1. Maya Elizabeth Kessler1,
  2. Rickey E Carter2,3,
  3. David A Cook4,5,
  4. Daryl Jon Kor3,6,
  5. Paul M McKie7,
  6. Laurie J Pencille3,4,
  7. Marianne R Scheitel4,
  8. Rajeev Chaudhry1,4
  1. 1 Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
  4. 4 Office of Information and Knowledge Management, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  6. 6 Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
  7. 7 Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Maya Elizabeth Kessler; kessler.maya{at}mayo.edu

Abstract

Introduction Clinical practice guidelines facilitate optimal clinical practice. Point of care access, interpretation and application of such guidelines, however, is inconsistent. Informatics-based tools may help clinicians apply guidelines more consistently. We have developed a novel clinical decision support tool that presents guideline-relevant information and actionable items to clinicians at the point of care. We aim to test whether this tool improves the management of hyperlipidaemia, atrial fibrillation and heart failure by primary care clinicians.

Methods/analysis Clinician care teams were cluster randomised to receive access to the clinical decision support tool or passive access to institutional guidelines on 16 May 2016. The trial began on 1 June 2016 when access to the tool was granted to the intervention clinicians. The trial will be run for 6 months to ensure a sufficient number of patient encounters to achieve 80% power to detect a twofold increase in the primary outcome at the 0.05 level of significance. The primary outcome measure will be the percentage of guideline-based recommendations acted on by clinicians for hyperlipidaemia, atrial fibrillation and heart failure. We hypothesise care teams with access to the clinical decision support tool will act on recommendations at a higher rate than care teams in the standard of care arm.

Ethics and dissemination The Mayo Clinic Institutional Review Board approved all study procedures. Informed consent was obtained from clinicians. A waiver of informed consent and of Health Insurance Portability and Accountability Act (HIPAA) authorisation for patients managed by clinicians in the study was granted. In addition to publication, results will be disseminated via meetings and newsletters.

Trial registration number NCT02742545.

  • health informatics
  • adult cardiology
  • internal medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors REC and MES were involved in the development and validation of the clinical decision support tool. All authors except MS contributed to the study design. All authors are involved in the implementation of the project. MEK, REC and MRS wrote the first draft of the manuscript. All other authors revised it critically and gave final approval for publication.

  • Competing interests None declared.

  • Ethics approval Mayo Clinic Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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