A study of clinical decision support system use has found that abiding by its recommendations can lower medical costs, adding weight to the notion that they might be worth deploying despite possible pushback from clinicians.
The study, which appeared in The American Journal of Managed Care, looked at the cost of care delivered by providers who adhered to CDS guidelines compared with care by nonadhering providers.
To conduct the study, researchers reviewed 26,424 patient encounters. In the treatment group, the provider adhered to all CDS recommendations, and in the control group, the provider did not do so. The encounters took place over three years.
The data they gathered regarding the encounters included alert status (adherence), provider type, patient demographics, clinical outcomes, Medicare status, and diagnosis information. The research team looked at the extent to which four outcome measures were associated with alert adherence, including encounter length of stay, odds of 30-day readmissions, odds of complications of care and total direct costs.
After conducting their analysis, the researchers found that the total encounter cost was 7.3% higher for nonadherent encounters than adherent ones, and that length of stay was 6.2% longer for nonadherent versus adherent encounters. They also found that the odds ratio for readmission within 30 days increased by 1.14, and the odds ratio for complications by 1.29, for nonadherent encounters versus adherent encounters.
Not surprisingly, given these results, the study’s authors suggest that provider organization should introduce real-time CDS support adherence to evidence-based guidelines.
It is worth noting, however, that the researchers inserted one caveat in their conclusion, warning that because they couldn’t tell what caused the association between CDS interventions and improved clinical and financial outcomes, it would be better to study the issue further.
Besides, getting clinicians on board can be painful, with many clicking through alerts without reading them and largely ignoring their content. In fact, another recent study found that almost 20% of CDS alert dismissals may be inappropriate.
Most of the inappropriate overrides were associated with an increased risk of adverse drug events. Overall, inappropriate overrides were six times as likely to be associated with potential and definite adverse drug events.