title: Clinical decision support improves physician guideline adherence for laboratory monitoring of chronic kidney disease: a matched cohort study.
abstract: BACKGROUND
  Guidelines exist for chronic kidney disease (CKD) but are not well implemented in clinical practice. We evaluated the impact of a guideline-based clinical decision support system (CDSS) on laboratory monitoring and achievement of laboratory targets in stage 3-4 CKD patients.
  
  
  METHODS
  We performed a matched cohort study of 12,353 stage 3-4 CKD patients whose physicians opted to receive an automated guideline-based CDSS with CKD-related lab results, and 42,996 matched controls whose physicians did not receive the CDSS. Physicians were from US community-based physician practices utilizing a large, commercial laboratory (LabCorp®). We compared the percentage of laboratory tests obtained within guideline-recommended intervals and the percentage of results within guideline target ranges between CDSS and non-CDSS patients. Laboratory tests analyzed included estimated glomerular filtration rate, plasma parathyroid hormone, serum calcium, phosphorus, 25-hydroxy vitamin D (25-D), total carbon dioxide, transferrin saturation (TSAT), LDL cholesterol (LDL-C), blood hemoglobin, and urine protein measurements.
  
  
  RESULTS
  Physicians who used the CDSS ordered all CKD-relevant testing more in accord with guidelines than those who did not use the system. Odds ratios favoring CDSS ranged from 1.29 (TSAT) to 1.88 (serum phosphorus) [CI, 1.20 to 2.01], p < 0.001 for all tests. The CDSS impact was greater for primary care physicians versus nephrologists. CDSS physicians met guideline targets for LDL-C and 25-D more often, but hemoglobin targets less often, than non-CDSS physicians. Use of CDSS did not impact guideline target achievement for the remaining tests.
  
  
  CONCLUSIONS
  Use of an automated laboratory-based CDSS may improve physician adherence to guidelines with respect to timely monitoring of CKD.
authors.affiliation: Litholink Corporation®, A LabCorp Company, Chicago, IL, USA. ennisj1@labcorp.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ennis
authors.affiliation: University of California at Irvine, Irvine, CA, USA. dgillen@uci.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gillen
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA. ahr@exchange.upenn.edu.
authors.forename: Arthur
authors.initials: A
authors.lastname: Rubenstein
authors.affiliation: University of Chicago, Chicago, IL, USA. eworcest@medicine.bsd.uchicago.edu.
authors.forename: Elaine
authors.initials: E
authors.lastname: Worcester
authors.affiliation: Laboratory Corporation of America® Holdings, Burlington, NC, USA. brechem@labcorp.com.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Brecher
authors.affiliation: Litholink Corporation®, A LabCorp Company, Chicago, IL, USA. asplinj@labcorp.com.
authors.forename: John
authors.initials: J
authors.lastname: Asplin
authors.affiliation: University of Chicago, Chicago, IL, USA. fcoe@medicine.bsd.uchicago.edu.
authors.forename: Fredric
authors.initials: F
authors.lastname: Coe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D002245:Carbon Dioxide / Q000097:blood; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood; D020000:Decision Support Systems, Clinical; D005260:Female; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007677:Kidney Function Tests / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data*; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011507:Proteinuria / Q000652:urine; D017010:Reminder Systems; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000503:physiopathology*; D061250:Transferrins / Q000097:blood; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D008078:Cholesterol, LDL; D006454:Hemoglobins; D010281:Parathyroid Hormone; D061250:Transferrins; D014807:Vitamin D; D002245:Carbon Dioxide; D010758:Phosphorus; C104450:25-hydroxyvitamin D; D002118:Calcium