title: Effect of computer-assisted European Best Practice Guideline implementation on adherence and target attainment: ORAMA results.
abstract: BACKGROUND
  The success of guidelines depends largely on effective implementation and uptake in clinical practice. The Optimal Renal Anemia Management Assessment (ORAMA) study investigated the impact of European Best Practice Guideline (EBPG) prompting on patient outcomes.
  
  
  METHODS
  ORAMA was a prospective, international, multicenter, cluster-randomized study. Fifty-three centers in eight European countries enrolled patients with chronic kidney disease stage V receiving chronic dialysis. Patients were either anemic (hemoglobin [Hb] <11 g/dL [110 g/L]) or treated with erythropoiesis stimulating agents and/or iron supplementation. Centers were randomized to two groups, with or without access to a computerized clinical decision support (CDS) system. In a post hoc analysis,patients were further subdivided into adherence or non-adherence of investigators to the EBPG regardless of CDS usage. Primary endpoint was the proportion of patients with Hb >11 g/ dL (110 g/L), reflecting hematological targets in the revised EPBG.
  
  
  RESULTS
  In this population of 599 dialysis patients, hematological targets did not differ in the presence or absence of a CDS system. There was a general shift towards improved patient distribution by Hb categories while the width of the distribution curves remained unchanged. The proportion of patients with Hb >11 g/dL (110 g/L) was higher among adherers (79% and 84% with or without CDS use, respectively) than non-adherers (59% and 57%, respectively).
  
  
  CONCLUSIONS
  ORAMA is the first international study to show that adherence to EBPG improved attainment of anemia indices. The availability of a CDS system did not affect anemia management.
authors.affiliation: Department of Nephrology, Dialysis and Renal Transplantation, A. Manzoni Hospital, Lecco, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.forename: Iain C
authors.initials: IC
authors.lastname: Macdougall
authors.forename: Armin
authors.initials: A
authors.lastname: Scherhag
authors.forename: Andrzej
authors.initials: A
authors.lastname: Wiecek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000209:etiology; D002908:Chronic Disease; D003658:Decision Making, Computer-Assisted; D005060:Europe; D005260:Female; D019983:Guideline Adherence / Q000639:trends*; D006284:Health Plan Implementation; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007391:International Cooperation; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000639:trends*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006454:Hemoglobins