Cluster randomized controlled trial of XXXX electronic decision support in primary care.

@entity1 @entity4905 @entity64 @entity204
OBJECTIVE: To test if @entity4905 / @entity64 electronic decision support in primary care improves management. METHODS: Multicenter, single-blind, parallel-group, cluster randomized, controlled trial comparing @entity4905 / @entity64 electronic decision support guided management with usual care. Main outcomes were guideline adherence and 90-day @entity64 risk. Secondary outcomes were cerebrovascular/vascular/ @entity204 /adverse events, cost, and user feedback. Main analysis was logistic regression with a normal random effect for clusters using a generalized linear mixed model. RESULTS: Twenty-nine clinics were randomized to intervention, 27 to control, recruiting 172 and 119 eligible @entity1 . More intervention @entity1 received guideline-adherent care (131/172; 76.2%) than control @entity1 (49/119; 41.2%) (adjusted odds ratio [OR] 4.57; 95% confidence interval [CI] 2.39-8.71; p < 0.001). Ninety-day @entity64 occurred in 2/172 (1.2%) intervention and 5/119 (4.2%) control @entity1 (OR 0.27; 95% CI 0.05-1.41; p = 0.098). Ninety-day @entity4905 or @entity64 occurrence was lower in the intervention group, 4/172 (2.3%) compared to 10/119 (8.5%) control (adjusted OR 0.26; 95% CI 0.70-0.97; p = 0.045). Fewer vascular events/ @entity204 occurred in intervention, 6/172 (3.5%), than in control @entity1 , 14/119 (11.9%) (adjusted OR 0.27; 95% CI 0.09-0.78; p = 0.016). Treatment cost ratio of 0.65 (95% CI 0.47-0.91; p = 0.013) favored the intervention without increased adverse events. Clinician feedback was positive. CONCLUSION: Primary care use of the @entity4905 / @entity64 electronic decision support tool improves guideline adherence, safely reduces treatment cost, achieves positive user feedback, and may reduce cerebrovascular and vascular event risk following @entity4905 / @entity64 . CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that a primary care electronic decision support tool improves guideline adherence and might reduce 90-day @entity64 risk.
