Study: Patients Do Better When Physicians Follow Computerized Alerts
August 15 2018 - 9:30AM
Business Wire
When physicians follow computer alerts embedded in electronic
health records, their hospitalized patients experience fewer
complications and lower costs, leave the hospital sooner and are
less likely to be readmitted, according to a study of inpatient
care.
The research examined alerts that popped up on physician
computer screens when their care instructions deviated from
evidence-based guidelines.
The alerts were based on an initiative called Choosing Wisely,
which identifies common tests and procedures that may not have
clear benefit for patients and should sometimes be avoided. For
example, an alert might pop up on the screen if a physician orders
a CT scan when it’s unnecessary and likely won’t improve the
patient’s outcome. The alert would serve as a reminder that the
order could expose the patient to unnecessary radiation and
costs.
The Choosing Wisely alerts were backed by the American Board of
Internal Medicine Foundation and created by various physician
subspecialty societies.
“Sometimes the best care for certain patient conditions means
doing less,” said Scott Weingarten, MD, MPH, chief clinical
transformation officer at Cedars-Sinai and a senior author of the
study. “We have seen that real-time aids for clinical
decision-making can potentially help physicians reduce low-value
care and improve patient outcomes while lowering costs.”
Many leaders in the healthcare industry have targeted
unnecessary care as a means of improving patient safety while
cutting wasteful spending. One 2010 estimate from the Institute of
Medicine found that “unnecessary services” contribute to about $210
billion in wasteful healthcare spending in the United States each
year.
The study, conducted by investigators from Cedars-Sinai and
Optum Advisory Services, was published in The American Journal of
Managed Care. It examined data from inpatient visits at
Cedars-Sinai Medical Center from October 2013 to July 2016 in which
one or more of the 18 most frequent alerts was triggered.
For 26,424 of the inpatient visits studied, the treating
physician followed either all or none of the Choosing Wisely
guidance. In 6 percent of visits, physicians in the “treatment
group” followed all triggered alerts; in the remaining 94 percent
of visits, physicians in the “control group” followed none of the
triggered alerts. An alert was triggered, for example, if a
physician tried ordering a sedative for a sleepless older patient
or an appetite stimulant for an older patient who was ill and
losing weight. Sedatives can put seniors at risk for falls, bone
fractures and car accidents, and appetite stimulants can put
seniors at risk of fluid retention, stroke and death.
The authors found a significant difference in health outcomes
and costs between the two groups. For patients whose physicians did
not follow the alerts, the odds of complications increased by 29
percent compared to the group whose physicians followed the alerts.
Likewise, the odds of hospital readmissions within 30 days of the
patients’ original visits was 14 percent higher in the group whose
physicians did not follow the alerts. Patients of these physicians
also saw a 6.2 percent increase in their length of stay and an
additional 7.3 percent – or $944 per patient – in costs, after
adjusting for differences in patient illness severity and case
complexity.
“Sometimes doctors order tests that they think are in the
patient’s best interest, when research doesn’t show that to be the
case. Unnecessary testing can lead to interventions that can cause
harm,” said Harry C. Sax, MD, executive vice chair of Surgery at
Cedars-Sinai and a senior author of the study. “This work is about
giving the right care that patients truly need.”
The authors acknowledge limitations to the study. Their strict
definition of alert compliance, which excluded visits in which
physicians followed some but not all alerts, limited their
understanding of the clinical and financial impact of those visits.
Additionally, the investigators were unable to measure the impact
of specific alerts on outcomes to see if one alert was more
significant than others. Finally, it is possible that physicians
with better patient outcomes and lower costs are more likely to
follow Choosing Wisely clinical decision support alerts, rather
than proving a “cause and effect” relationship between following
the alerts and better outcomes.
Disclosures: Optum is a licensed reseller of Stanson Health,
including its Choosing Wisely alert content evaluated in this
study. Cedars-Sinai is the major shareholder of Stanson Health and
employs the company’s founders, Darren Dworkin, Cedars-Sinai chief
information officer and stockholder of Stanson Health, and
Weingarten, who is chairman of the board and stockholder of Stanson
Health.
About Cedars-Sinai
Cedars-Sinai is a leader in providing high-quality healthcare
encompassing primary care, specialized medicine and research. Since
1902, Cedars-Sinai has evolved to meet the needs of one of the most
diverse regions in the nation, setting standards in quality and
innovative patient care, research, teaching and community service.
Today, Cedars-Sinai is known for its national leadership in
transforming healthcare for the benefit of
patients. Cedars-Sinai impacts the future of healthcare by
developing new approaches to treatment and educating tomorrow’s
health professionals. Additionally, Cedars-Sinai demonstrates a
commitment to the community through programs that improve the
health of its most vulnerable residents.
About Optum
Optum is a leading information and technology-enabled health
services business dedicated to helping make the health system work
better for everyone. With more than 135,000 people worldwide, Optum
delivers intelligent, integrated solutions that help to modernize
the health system and improve overall population health. Optum is
part of UnitedHealth Group (NYSE:UNH). For more information,
visit www.optum.com.
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version on businesswire.com: https://www.businesswire.com/news/home/20180815005214/en/
Cedars-SinaiMarni Usheroff,
323-866-6221Marni.Usheroff@cshs.orgcedars-sinai.orgSocial Media:
@CedarsSinaiorOptumPete Simpkinson,
202-266-6645SimpkinP@advisory.comwww.optum.comSocial Media:
@Optum
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