Comparing Effects of Patient-specific Versus Non-patient-specific Computerized Reminder System

Study Overview
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Brief Summary
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The investigators hypothesize that a Clinical Decision Support System (CDSS) designed with Patient-Specific reminders yields superior performance than that with Non-patient-specific reminders in preventing contrast-induced nephropathy.

Detailed Description
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We hypothesize that a clinical decision support system (CDSS) designed with Patient-specific reminders yields superior performance than that with Non-patient-specific reminders in preventing contrast-induced nephropathy. A 3-arm randomized controlled trial (RCT) will be performed by cluster randomization using physicians as the unit of allocation. Physicians in 3 university medical centers will be randomly assigned into 1) patient-specific arm with Anti Contrast-Induced-Nephropathy(Anti-CIN) reminder, 2) non-patient-specific reminder arm, and 3) the control arm without any reminders, respectively. The patient-specific alert, Anti-CIN system, is designed as a real-time CDSS implementation on CPOE for monitoring physician's contrast-enhanced CT and IVP orders. Computerized pop-up reminders provide the patient-specific encounters with optimal decision options when patients are at a high CIN risk or patients with unknown risk factors are encountered. Non-patient-specific reminders always pop up no matter whether the patient is at a high risk or not.

Official Title
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Randomized Controlled Trial: Comparing Effects of Patient-Specific Versus Non-Patient-Specific Computerized Reminder System to Reduce Contrast-Induced Nephropathy

Conditions
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Radiographic Contrast Agent Nephropathy

Intervention / Treatment
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* Other: Patient-specific computerized reminder
* Other: Non-patient-specific computerized reminder


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Our intervention targets are physicians but not patients. All physicians working in the hospital may join this trial. Exclusion Criteria: The physician who never orders a CT scan or IVU study will be excluded The physician who never operates the CPOE by himself or herself will be excluded

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patient-specific reminder<br>Intervention: Patient-specific computerized reminder. The physicians assigned to this arm will use the patient-specific CDSS on CPOE. The patient-specific reminder is designed as a real-time CDSS implemented on CPOE to monitor physician's contrast-enhanced image study orders. Computerized pop-up reminders provide the patient-specific CIN risk profile and optimal decision options which are generated when patients with high risk or with unknown risk of CIN are encountered. | Other: Patient-specific computerized reminder<br>* The intervention targets are physicians,not patients. This CDSS alerts physicians only when the patient with high risk of contrast-induced-nephropathy(CIN) is encountered. On the contrast, the CDSS will not alert when the patient without CIN risk is encountered.<br>* Other names: Patient-specific CDSS;|
| Active Comparator: Non-patient-specific reminder<br>Intervention: Non-patient-specific Computerized reminder. The physicians assigned to this arm will use the Non-patient-specific reminders through CPOE. Non-patient-specific reminders always pops up to remind physicians to check their patient's CIN risk no matter what CIN risk is. | Other: Non-patient-specific computerized reminder<br>* The non-patient-specific computerized reminder always pops up to remind physicians to check their patient's CIN risk no matter what CIN risk is.<br>* Other names: Non-patient-specific CDSS;|
| No Intervention: Control Arm<br>The physicians assigned to this arm will not use and any computerized reminder. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The percentage of contrast-enhanced imaging(CEI) orders with high CIN risk | The number of CEI ordered for patients at high CIN risk, divided by the total number of CEI orders. [CEI]: contrast-enhanced image studies,such as CT or IVU. [CIN]: contrast-induced nephropathy | Physicains who participated in this trial will be followed for an expected average of 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The order elimination rate of high CIN risk orders attributed to the computerized reminder | The number of CEI orders with high CIN risk cancelled by the physician attributed to our computerized reminder, divided by the total number of CEI orders with high CIN risk. | Physicains who participated in this trial will be followed for an expected average of 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Clinical Decision Support Systems, Contrast-induced nephropathy