• Gregory K Robbins, William Lester, Kristin L Johnson, Yuchiao Chang, Gregory Estey, Dominic Surrao, Kimon Zachary, Sara M Lammert, Henry C Chueh, James B Meigs, and Kenneth A Freedberg.
• Massachusetts General Hospital, Division of Infectious Diseases, 55 Fruit Street, Cox 5, Boston, MA 02114, USA. grobbins@partners.org
• Ann. Intern. Med. 2012 Dec 4; 157 (11): 757766757-66.

BackgroundData to support improved patient outcomes from clinical decision-support systems (CDSSs) are lacking in HIV care.ObjectiveTo test the efficacy of a CDSS in improving HIV outcomes in an outpatient clinic.DesignRandomized, controlled trial. (ClinicalTrials.gov registration number: NCT00678600)SettingMassachusetts General Hospital HIV Clinic.ParticipantsHIV care providers and their patients.InterventionComputer alerts were generated for virologic failure (HIV RNA level >400 copies/mL after a previous HIV RNA level ≤400 copies/mL), evidence of suboptimal follow-up, and 11 abnormal laboratory test results. Providers received interactive computer alerts, facilitating appointment rescheduling and repeated laboratory testing, for half of their patients and static alerts for the other half.MeasurementsThe primary end point was change in CD4 cell count. Other end points included time to clinical event, 6-month suboptimal follow-up, and severe laboratory toxicity.ResultsThirty-three HIV care providers followed 1011 patients with HIV. In the intervention group, the mean increase in CD4 cell count was greater (0.0053 vs. 0.0032 × 109 cells/L per month; difference, 0.0021 × 109 cells/L per month [95% CI, 0.0001 to 0.004]; P = 0.040) and the rate of 6-month suboptimal follow-up was lower (20.6 vs. 30.1 events per 100 patient-years; P = 0.022) than those in the control group. Median time to next scheduled appointment was shorter in the intervention group than in the control group after a suboptimal follow-up alert (1.71 vs. 3.48 months; P < 0.001) and after a toxicity alert (2.79 vs. >6 months; P = 0.072). More than 90% of providers supported adopting the CDSS as part of standard care.LimitationThis was a 1-year informatics study conducted at a single hospital subspecialty clinic.ConclusionA CDSS using interactive provider alerts improved CD4 cell counts and clinic follow-up for patients with HIV. Wider implementation of such systems can provide important clinical benefits.Primary Funding SourceNational Institute of Allergy and Infectious Diseases.

30 keywords...

hide…