title: Effect of a clinical trial alert system on physician participation in trial recruitment.
abstract: BACKGROUND
  Failure to recruit a sufficient number of eligible subjects in a timely manner represents a major impediment to the success of clinical trials. Physician participation is vital to trial recruitment but is often limited.
  
  
  METHODS
  After 12 months of traditional recruitment to a clinical trial, we activated our electronic health record (EHR)-based clinical trial alert (CTA) system in selected outpatient clinics of a large, US academic health care system. When a patient's EHR data met selected trial criteria during the subsequent 4-month intervention period, the CTA prompted physician consideration of the patient's eligibility and facilitated secure messaging to the trial's coordinator. Subjects were the 114 physicians practicing at selected EHR-equipped clinics throughout our study. We compared differences in the number of physicians participating in recruitment and their recruitment rates before and after CTA activation.
  
  
  RESULTS
  The CTA intervention was associated with significant increases in the number of physicians generating referrals (5 before and 42 after; P < .001) and enrollments (5 before and 11 after; P = .03), a 10-fold increase in those physicians' referral rate (5.7/mo before and 59.5/mo after; rate ratio, 10.44; 95% confidence interval, 7.98-13.68; P<.001), and a doubling of their enrollment rate (2.9/mo before and 6.0/mo after; rate ratio, 2.06; 95% confidence interval, 1.22-3.46; P = .007).
  
  
  CONCLUSIONS
  Use of an EHR-based CTA led to significant increases in physicians' participation in and recruitment rates to an ongoing clinical trial. Given the trend toward the EHR implementation in health care centers engaged in clinical research, this approach may represent a much-needed solution to the common problem of inadequate trial recruitment.
authors.affiliation: Division of General Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0535, USA. peter.embi@uc.edu
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Embi
authors.forename: Anil
authors.initials: A
authors.lastname: Jain
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Clark
authors.forename: Susan
authors.initials: S
authors.lastname: Bizjack
authors.forename: Richard
authors.initials: R
authors.lastname: Hornung
authors.forename: C Martin
authors.initials: CM
authors.lastname: Harris
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002986:Clinical Trials as Topic / Q000379:methods*; D003299:Cooperative Behavior; D017144:Focus Groups; D006801:Humans; D018579:Patient Selection; D010819:Physician's Role; D012017:Referral and Consultation / Q000458:organization & administration; D011795:Surveys and Questionnaires