title: Clinical and economic results from a randomized trial of clinical decision support in a rural health network.
abstract: BACKGROUND
  Replication studies evaluate technologies in usual use settings.
  
  
  METHODS
  We conducted a clinical trial to determine whether reductions in clinical and economic results observed in a previous study could be replicated in a larger setting. Subjects were randomized to receive intervention (email notifications for sentinel health events sent to their care managers) or control.
  
  
  METHODS
  The primary outcome was the rate of emergency department visits for low severity conditions. Secondary outcomes included: medical costs and other clinical event rates.
  
  
  RESULTS
  We randomized 13,454 individuals (intervention, 6740; control, 6714). Subjects in both groups had similar rates of clinical events and medical costs.
  
  
  CONCLUSIONS
  The use of email notifications to care managers was associated with no reductions in clinical events or medical costs.
authors.affiliation: Division of Clinical Informatics, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kawamoto
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Janese M
authors.initials: JM
authors.lastname: Willis
authors.forename: Garry M
authors.initials: GM
authors.lastname: Silvey
authors.forename: Fred S
authors.initials: FS
authors.lastname: Johnson
authors.forename: Rex
authors.initials: R
authors.lastname: Edwards
authors.forename: Jean
authors.initials: J
authors.lastname: Mise
authors.forename: Susan D
authors.initials: SD
authors.lastname: Yaggy
authors.forename: David F
authors.initials: DF
authors.lastname: Lobach
mesh_terms: D017046:Cost Savings; D003365:Costs and Cost Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D009657:North Carolina; D017063:Outcome Assessment, Health Care / Q000379:methods*; D019035:Rural Health Services / Q000191:economics*; D018571:Sentinel Surveillance