title: Efficacy of a clinical decision-support system in an HIV practice: a randomized trial.
abstract: BACKGROUND
  Data to support improved patient outcomes from clinical decision-support systems (CDSSs) are lacking in HIV care.
  
  
  OBJECTIVE
  To test the efficacy of a CDSS in improving HIV outcomes in an outpatient clinic.
  
  
  METHODS
  Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00678600)
  
  
  METHODS
  Massachusetts General Hospital HIV Clinic.
  
  
  METHODS
  HIV care providers and their patients.
  
  
  METHODS
  Computer alerts were generated for virologic failure (HIV RNA level >400 copies/mL after a previous HIV RNA level ≤400 copies/mL), evidence of suboptimal follow-up, and 11 abnormal laboratory test results. Providers received interactive computer alerts, facilitating appointment rescheduling and repeated laboratory testing, for half of their patients and static alerts for the other half.
  
  
  METHODS
  The primary end point was change in CD4 cell count. Other end points included time to clinical event, 6-month suboptimal follow-up, and severe laboratory toxicity.
  
  
  RESULTS
  Thirty-three HIV care providers followed 1011 patients with HIV. In the intervention group, the mean increase in CD4 cell count was greater (0.0053 vs. 0.0032 × 109 cells/L per month; difference, 0.0021 × 109 cells/L per month [95% CI, 0.0001 to 0.004]; P = 0.040) and the rate of 6-month suboptimal follow-up was lower (20.6 vs. 30.1 events per 100 patient-years; P = 0.022) than those in the control group. Median time to next scheduled appointment was shorter in the intervention group than in the control group after a suboptimal follow-up alert (1.71 vs. 3.48 months; P < 0.001) and after a toxicity alert (2.79 vs. >6 months; P = 0.072). More than 90% of providers supported adopting the CDSS as part of standard care.
  
  
  CONCLUSIONS
  This was a 1-year informatics study conducted at a single hospital subspecialty clinic.
  
  
  CONCLUSIONS
  A CDSS using interactive provider alerts improved CD4 cell counts and clinic follow-up for patients with HIV. Wider implementation of such systems can provide important clinical benefits.
  
  
  BACKGROUND
  National Institute of Allergy and Infectious Diseases.
authors.affiliation: Massachusetts General Hospital, Division of Infectious Diseases, 55 Fruit Street, Cox 5, Boston, MA 02114, USA. grobbins@partners.org
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Robbins
authors.forename: William
authors.initials: W
authors.lastname: Lester
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Johnson
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Gregory
authors.initials: G
authors.lastname: Estey
authors.forename: Dominic
authors.initials: D
authors.lastname: Surrao
authors.forename: Kimon
authors.initials: K
authors.lastname: Zachary
authors.forename: Sara M
authors.initials: SM
authors.lastname: Lammert
authors.forename: Henry C
authors.initials: HC
authors.lastname: Chueh
authors.forename: James B
authors.initials: JB
authors.lastname: Meigs
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D001071:Appointments and Schedules; D018791:CD4 Lymphocyte Count; D020000:Decision Support Systems, Clinical / Q000592:standards*; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008404:Massachusetts; D017063:Outcome Assessment, Health Care; D012333:RNA, Messenger / Q000097:blood; D017010:Reminder Systems / Q000592:standards; D013997:Time Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012333:RNA, Messenger