title: Effects of documentation-based decision support on chronic disease management.
abstract: OBJECTIVE
  To evaluate whether a new documentation-based clinical decision support system (CDSS) is effective in addressing deficiencies in the care of patients with coronary artery disease (CAD) and diabetes mellitus (DM).
  
  
  METHODS
  Controlled trial randomized by physician.
  
  
  METHODS
  We assigned primary care physicians (PCPs) in 10 ambulatory practices to usual care or the CAD/DM Smart Form for 9 months. The primary outcome was the proportion of deficiencies in care that were addressed within 30 days after a patient visit.
  
  
  RESULTS
  The Smart Form was used for 5.6% of eligible patients. In the intention-to-treat analysis, patients of intervention PCPs had a greater proportion of deficiencies addressed within 30 days of a visit compared with controls (11.4% vs 10.1%, adjusted and clustered odds ratio =1.14; 95% confidence interval, 1.02-1.28; P = .02). Differences were more pronounced in the "on-treatment" analysis: 17.0% of deficiencies were addressed after visits in which the Smart Form was used compared with 10.6% of deficiencies after visits in which it was not used (P <.001). Measures that improved included documentation of smoking status and prescription of antiplatelet agents when appropriate.
  
  
  CONCLUSIONS
  Overall use of the CAD/DM Smart Form was low, and improvements in management were modest. When used, documentation-based decision support shows promise, and future studies should focus on refining such tools, integrating them into current electronic health record platforms, and promoting their use, perhaps through organizational changes to primary care practices.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA. jschnipper@partners.org
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
authors.forename: Matvey B
authors.initials: MB
authors.lastname: Palchuk
authors.forename: D Tony
authors.initials: DT
authors.lastname: Yu
authors.forename: Kerry E
authors.initials: KE
authors.lastname: McColgan
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Volk
authors.forename: Ruslana
authors.initials: R
authors.lastname: Tsurikova
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Melnikas
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Einbinder
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D003324:Coronary Artery Disease / Q000628:therapy*; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000628:therapy*; D057286:Electronic Health Records; D006801:Humans; D057194:Intention to Treat Analysis; D008404:Massachusetts; D017063:Outcome Assessment, Health Care; D010820:Physicians; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*