title: Computerized alert reduced D-dimer testing in the elderly.
abstract: OBJECTIVE
  To assess the effect of a targeted age-specific computerized alert to reduce D-dimer testing in elderly patients.
  
  
  METHODS
  A single-crossover cluster randomized trial of computerized alerts during physician order entry involving 8 ambulatory care clinics in a group-model integrated care delivery system.
  
  
  METHODS
  The rate of completed D-dimer tests per 1000 patient visits, ratio of completed venous ultrasonography to completed D-dimer tests, and rate of completed venous ultrasonography per 1000 patient visits.
  
  
  RESULTS
  The rate of completed D-dimer tests per 1000 visits among patients 65 years and older in intervention clinics decreased from 5.02 to 1.52 (95% confidence interval [CI], -4.20 to -2.80; P <.001), which persisted throughout the study period. The rate of completed D-dimer tests per 1000 visits among patients 65 years and older in control clinics decreased from 3.14 to 2.11 (95% CI, -1.66 to -0.04; P <.001 for interaction). After activation of the alert in control clinics, the rate of completed D-dimer tests per 1000 visits among patients 65 years and older decreased from 2.11 to 0.81 (95% Cl, -1.79 to -0.80; P <.001). After activation of the alert in each clinic group, the ratios of completed venous ultrasonography to completed D-dimer tests increased from 1.17 to 4.05 (95% CI, 2.52-3.22) and from 2.25 to 7.29 (95% CI, 3.74-6.35) in intervention clinics and control clinics, respectively (P <.001 for both).
  
  
  CONCLUSIONS
  An electronic age-specific alert targeted to a specific condition reduced D-dimer testing in this elderly population of outpatients and demonstrated a persistent effect.
authors.affiliation: Institute for Health Research, Kaiser Permanente of Colorado, PO Box 378066, Denver, CO 80237-8066, USA. ted.e.palen@kp.org
authors.forename: Ted E
authors.initials: TE
authors.lastname: Palen
authors.forename: David W
authors.initials: DW
authors.lastname: Price
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Snyder
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shetterly
mesh_terms: D000367:Age Factors; D000368:Aged; D000933:Antifibrinolytic Agents / Q000032:analysis; D016000:Cluster Analysis; D018592:Cross-Over Studies; D003658:Decision Making, Computer-Assisted; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D010045:Outpatients; D011655:Pulmonary Embolism / Q000175:diagnosis; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging*; D054556:Venous Thromboembolism / Q000175:diagnosis*; D020246:Venous Thrombosis / Q000175:diagnosis
chemical_list: D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D