title: Outcomes of clinical decision support (CDS) and correlates of CDS use for home care patients with high medication regimen complexity: a randomized trial.
abstract: OBJECTIVE
  To assess the outcomes of a clinical decision support (CDS) intervention designed for home care patients with high medication regimen complexity (MRC) and to examine correlates of CDS use.
  
  
  METHODS
  The CDS consisted of a computerized algorithm that identified high MRC patients, electronic alerts and a care management module. Nurses were randomized upon identification of an eligible patient. Full intention to treat and intervention group-only analyses were completed. Regression-adjusted outcomes were hospitalization, emergency department use and reduction in MRC.
  
  
  RESULTS
  Five hundred nurses were randomized with 7919 of their patients. Approximately 20% of the intervention group was hospitalized versus 21% in the control group; 16.5% versus 16.7% had an emergency department visit; and 6% in each group dropped below the high MRC threshold. No statistically significant differences were found in the intention to treat analysis. Eighty-two percent of intervention nurses used the CDS but for only 42% of their patients. Among intervention patients, CDS use (vs. non-use) was associated with reduced MRC and hospitalization. CDS use was associated with various clinician and patient characteristics.
  
  
  CONCLUSIONS
  CDS use was limited, negating the impact of the intervention overall. Findings on correlates of CDS use and the relationship between CDS use and positive outcomes suggest that CDS use and outcomes could be enhanced by avoiding short patient lengths of stay, improving continuity of care, increasing reliance on salaried nurses and/or increasing per diem nurses' incentives to use CDS.
authors.affiliation: Data Science and Strategic Analytic, VNS Outcomes Initiative, New York, NY, USA.
authors.forename: Margaret V
authors.initials: MV
authors.lastname: McDonald
authors.affiliation: Data Science and Strategic Analytic, VNS Outcomes Initiative, New York, NY, USA.
authors.forename: Penny H
authors.initials: PH
authors.lastname: Feldman
authors.affiliation: Data Science and Strategic Analytic, VNS Outcomes Initiative, New York, NY, USA.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Barrón-Vayá
authors.affiliation: Data Science and Strategic Analytic, VNS Outcomes Initiative, New York, NY, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Peng
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, USA.
authors.forename: Sridevi
authors.initials: S
authors.lastname: Sridharan
authors.affiliation: Department of Medicine and Health Policy Institute, Medical College of Wisconsin, Madison, WI, USA.
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Pezzin
mesh_terms: D000328:Adult; D016208:Databases, Factual; D020000:Decision Support Systems, Clinical; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D017063:Outcome Assessment, Health Care; D019338:Polypharmacy; D018570:Risk Assessment / Q000379:methods
keywords: MRCI; clinical decision support; home health care; hospitalization risk; medication regimen complexity; nurses