title: Impact of four training conditions on physician use of a web-based clinical decision support system.
abstract: BACKGROUND
  Training has been identified as an important barrier to implementation of clinical decision support systems (CDSSs), but little is known about the effectiveness of different training approaches.
  
  
  METHODS
  Using an observational retrospective cohort design, we examined the impact of four training conditions on physician use of a CDSS: (1) computer lab training with individualized follow-up (CL-FU) (n=40), (2) computer lab training without follow-up (CL) (n=177), (3) lecture demonstration (LD) (n=16), or (4) no training (NT) (n=134). Odds ratios of any use and ongoing use under training conditions were compared to no training over a 2-year follow-up period.
  
  
  RESULTS
  CL-FU was associated with the highest percent of active users and odds for any use (90.0%, odds ratio (OR)=10.2, 95% confidence interval (CI): 3.2-32.9) and ongoing use (60.0%, OR=6.1 95% CI: 2.6-13.7), followed by CL (any use=81.4%, OR=5.3, CI: 2.9-9.6; ongoing use=28.8%, OR=1.7, 95% CI: 1.0-3.0). LD was not superior to no training (any use=47%, ongoing use=22.4%).
  
  
  CONCLUSIONS
  Training format may have differential effects on initial and long-term follow-up of CDSSs use by physicians.
authors.affiliation: New York State Office of Mental Health, 1051 Riverside Drive, Unit 104, New York, NY 10032, USA.
authors.forename: Edith
authors.initials: E
authors.lastname: Kealey
authors.forename: Emily
authors.initials: E
authors.lastname: Leckman-Westin
authors.forename: Molly T
authors.initials: MT
authors.lastname: Finnerty
mesh_terms: D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D007318:Inservice Training / Q000458:organization & administration*; D020407:Internet; D010820:Physicians
keywords: Clinical decision support system (CDSS); Generalized linear multilevel model (GLMM); Health information technology (HIT); Physician computer training