Among CVRM patients , the results tended towards a beneficial effect of CDSS , but only LDL-c target attainment in diabetes patients reached statistical significance .
Prompting , integration into the electronical health record , patient empowerment , and medication support were related to more effective CVRM .
Conclusion We did not find a clear clinical benefit from CDSS in cardiovascular risk factor levels and target attainment .
Some features of CDSS seem more promising than others .
Clinical relevance of CDSS in CVRM might additionally be sought in the improvement of shared decision making and patient empowerment
Background Cardiovascular risk management ( CVRM ) is notoriously difficult because of multi-morbidity and the different phenotypes and severities of cardiovascular disease .
Computerized decision support systems ( CDSS ) enable the clinician to integrate the latest scientific evidence and patient information into tailored strategies .
The effect on cardiovascular risk factor management is yet to be confirmed .
Effect of computer-assisted European Best Practice Guideline implementation on adherence and target attainment: ORAMA results.
BACKGROUND The success of guidelines depends largely on effective implementation and uptake in clinical practice . The Optimal Renal Anemia Management Assessment ( ORAMA ) study investigated the impact of European Best Practice Guideline ( EBPG ) prompting on patient outcomes . METHODS ORAMA was a prospect i ve , international , multicenter , cluster-r and omized study . Fifty-three centers in eight European countries enrolled patients with chronic kidney disease stage V receiving chronic dialysis . Patients were either anemic ( hemoglobin [ Hb ] < 11 g/dL [ 110 g/L ] ) or treated with erythropoiesis stimulating agents and /or iron supplementation .  Centers were r and omized to two groups , with or without access to a computerized clinical decision support ( CDS ) system . In a post hoc analysis , patients were further subdivided into adherence or non-adherence of investigators to the EBPG regardless of CDS usage . Primary endpoint was the proportion of patients with Hb > 11 g/ dL ( 110 g/L ) , reflecting hematological targets in the revised EPBG . RESULTS In this population of 599 dialysis patients , hematological targets did not differ in the presence or absence of a CDS system . There was a general shift towards improved patient distribution by Hb categories while the width of the distribution curves remained unchanged . The proportion of patients with Hb > 11 g/dL ( 110 g/L ) was higher among adherers ( 79 % and 84 % with or without CDS use , respectively ) than non-adherers ( 59 % and 57 % , respectively ) . CONCLUSIONS ORAMA is the first international study to show that adherence to EBPG improved attainment of anemia indices . The availability of a CDS system did not affect anemia management
Among CVRM patients , the results tended towards a beneficial effect of CDSS , but only LDL-c target attainment in diabetes patients reached statistical significance .
Prompting , integration into the electronical health record , patient empowerment , and medication support were related to more effective CVRM .
Conclusion We did not find a clear clinical benefit from CDSS in cardiovascular risk factor levels and target attainment .
Some features of CDSS seem more promising than others .
Clinical relevance of CDSS in CVRM might additionally be sought in the improvement of shared decision making and patient empowerment
Background Cardiovascular risk management ( CVRM ) is notoriously difficult because of multi-morbidity and the different phenotypes and severities of cardiovascular disease .
Computerized decision support systems ( CDSS ) enable the clinician to integrate the latest scientific evidence and patient information into tailored strategies .
The effect on cardiovascular risk factor management is yet to be confirmed .