title: Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?
abstract: OBJECTIVE
  Physicians typically respond to roughly half of the clinical decision support prompts they receive. This study was designed to test the hypothesis that selectively highlighting prompts in yellow would improve physicians' responsiveness.
  
  
  METHODS
  We conducted a randomized controlled trial using the Child Health Improvement Through Computer Automation clinical decision support system in 4 urban primary care pediatric clinics. Half of a set of electronic prompts of interest was highlighted in yellow when presented to physicians in 2 clinics. The other half of the prompts was highlighted when presented to physicians in the other 2 clinics. Analyses compared physician responsiveness to the 2 randomized sets of prompts: highlighted versus not highlighted. Additionally, several prompts deemed high priority were highlighted during the entire study period in all clinics. Physician response rates to the high-priority highlighted prompts were compared to response rates for those prompts from the year before the study period, when they were not highlighted.
  
  
  RESULTS
  Physicians did not respond to prompts that were highlighted at higher rates than prompts that were not highlighted (62% and 61%, respectively; odds ratio 1.056, P = .259, NS). Similarly, physicians were no more likely to respond to high-priority prompts that were highlighted compared to the year before, when the prompts were not highlighted (59% and 59%, respectively, χ(2) = 0.067, P = .796, NS).
  
  
  CONCLUSIONS
  Highlighting reminder prompts did not increase physicians' responsiveness. We provide possible explanations why highlighting did not improve responsiveness and offer alternative strategies to increasing physician responsiveness to prompts.
authors.affiliation: Children's Health Services Research, Indianapolis, Ind; Regenstrief Institute Inc, Indianapolis, Ind. Electronic address: kshendri@iu.edu.
authors.forename: Kristin S
authors.initials: KS
authors.lastname: Hendrix
authors.affiliation: Children's Health Services Research, Indianapolis, Ind; Regenstrief Institute Inc, Indianapolis, Ind.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Downs
authors.affiliation: Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind; Regenstrief Institute Inc, Indianapolis, Ind.
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Carroll
mesh_terms: D020000:Decision Support Systems, Clinical; D006801:Humans; D016017:Odds Ratio; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D058996:Quality Improvement; D017010:Reminder Systems
keywords: alert fatigue; clinical decision support; pediatric; prompts; reminders