title: Population-based clinical decision support: a clinical and economic evaluation.
abstract: Governments are investing in health information technologies (HIT) to improve care quality and reduce medical costs. However, evidence of these benefits is limited. We conducted a randomized trial of three clinical decision support (CDS) interventions in 20,180 patients: email to care managers (n=3329), reports to primary care administrators (n=3368), letters to patients (n=3401), and controls (10,082). At 7-month follow-up, the letters to patients group had greater use of outpatient services and higher outpatient and total medical costs; whereas, the other groups had no change in clinical events or medical costs. As our CDS interventions were associated with no change or an increase in medical costs, it appears that investments in HIT without consideration for organizational context may not be sufficient to achieve improvements in clinical and economic outcomes.
authors.affiliation: Duke University Medical Center, Durham, NC, USA. eric.eisenstein@duke.edu
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Rex
authors.initials: R
authors.lastname: Edwards
authors.forename: Janese M
authors.initials: JM
authors.lastname: Willis
authors.forename: Jessica
authors.initials: J
authors.lastname: Simo
authors.forename: David F
authors.initials: DF
authors.lastname: Lobach
mesh_terms: D003363:Cost Control / Q000379:methods; D003362:Cost-Benefit Analysis / Q000379:methods; D020000:Decision Support Systems, Clinical / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000191:economics*; D008490:Medical Informatics / Q000191:economics*; D014481:United States