title: Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation.
abstract: OBJECTIVE
  To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, or repeated sooner than recommended due to preparation (prep) quality; prep quality; colonoscopy duration; and patient satisfaction with and tolerance of the preparation.
  
  
  METHODS
  We used 4 alternating 4-week periods to compare the decision tool with usual care for outpatient colonoscopy. All decision tool decisions were reviewed in real-time by gastroenterology nurses and/or physicians. Patients completed a survey about the prep process. Endoscopists blindly rated prep quality. Colonoscopy duration and findings were recorded.
  
  
  RESULTS
  Of 354 persons in the decision tool group, 4 prep decisions were overridden because of patient preference or prior prep failure, but none for medical reasons. Sodium phosphate was used more frequently in the decision tool group (73% vs. 41%; P < 0.01). There was no difference between the decision tool and usual care groups in the composite outcome (26% vs. 30%, respectively; P = 0.29), acceptable prep quality (62% vs. 56%; P = 0.22), colonoscopy duration (28 vs. 30 min; P = 0.17), patient satisfaction (P = 0.38), or preparation tolerance (P = 0.37).
  
  
  CONCLUSIONS
  An electronic medical record-based decision tool can safely and effectively tailor the prep for colonoscopy and may improve colonoscopy efficiency and patient satisfaction.
  
  
  CONCLUSIONS
  This study was performed at a single VA medical center and endoscopy unit, relies on the presence of relevant medical conditions and laboratory data in the electronic medical record, and had a higher than expected use of sodium phosphate during usual care.
authors.affiliation: Center of Excellence for Implementation of Evidence-based Research, Health Services Research and Development, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States. timperia@iupui.edu
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sherer
authors.forename: Jo Ann D
authors.initials: JA
authors.lastname: Balph
authors.forename: Jon D
authors.initials: JD
authors.lastname: Cardwell
authors.forename: Rong
authors.initials: R
authors.lastname: Qi
mesh_terms: D000284:Administration, Oral; D002400:Cathartics / Q000008:administration & dosage*; D003113:Colonoscopy; D003658:Decision Making, Computer-Assisted; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010710:Phosphates / Q000008:administration & dosage*; D010820:Physicians / Q000523:psychology*; D024382:Professional Role
chemical_list: D002400:Cathartics; D010710:Phosphates; C018279:sodium phosphate