Randomized Controlled Trial: Comparing Effects of Patient-Specific Versus Non-Patient-Specific Computerized Reminder System to Reduce Contrast-Induced Nephropathy
Trial Snapshot
- Phase
- Not Applicable
- Sponsor
- Taipei Medical University
- Enrollment
- 90
- Locations
- 1
- Primary Endpoint
- The percentage of contrast-enhanced imaging(CEI) orders with high CIN risk
Study Overview
Brief Summary
The investigators hypothesize that a Clinical Decision Support System (CDSS) designed with "Patient-Specific" reminders yields superior performance than that with "Non-patient-specific" reminders in preventing contrast-induced nephropathy.
Detailed Description
We hypothesize that a clinical decision support system (CDSS) designed with "Patient-specific" reminders yields superior performance than that with "Non-patient-specific" reminders in preventing contrast-induced nephropathy.
A 3-arm randomized controlled trial (RCT) will be performed by cluster randomization using physicians as the unit of allocation. Physicians in 3 university medical centers will be randomly assigned into 1) patient-specific arm with Anti Contrast-Induced-Nephropathy(Anti-CIN) reminder, 2) non-patient-specific reminder arm, and 3) the control arm without any reminders, respectively.
The patient-specific alert, Anti-CIN system, is designed as a real-time CDSS implementation on CPOE for monitoring physician's contrast-enhanced CT and IVP orders. Computerized pop-up reminders provide the patient-specific encounters with optimal decision options when patients are at a high CIN risk or patients with unknown risk factors are encountered. Non-patient-specific reminders always pop up no matter whether the patient is at a high risk or not.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 25 Years to 70 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Our intervention targets are physicians but not patients. All physicians working in the hospital may join this trial.
Exclusion Criteria
- •The physician who never orders a CT scan or IVU study will be excluded
- •The physician who never operates the CPOE by himself or herself will be excluded
Arms & Interventions
Patient-specific reminder
Intervention: Patient-specific computerized reminder. The physicians assigned to this arm will use the patient-specific CDSS on CPOE. The patient-specific reminder is designed as a real-time CDSS implemented on CPOE to monitor physician's contrast-enhanced image study orders. Computerized pop-up reminders provide the patient-specific CIN risk profile and optimal decision options which are generated when patients with high risk or with unknown risk of CIN are encountered.
Intervention: Patient-specific computerized reminder (Other)
Non-patient-specific reminder
Intervention: Non-patient-specific Computerized reminder. The physicians assigned to this arm will use the Non-patient-specific reminders through CPOE. Non-patient-specific reminders always pops up to remind physicians to check their patient's CIN risk no matter what CIN risk is.
Intervention: Non-patient-specific computerized reminder (Other)
Control Arm
The physicians assigned to this arm will not use and any computerized reminder.
Outcomes
Primary Outcomes
The percentage of contrast-enhanced imaging(CEI) orders with high CIN risk
Time Frame: Physicains who participated in this trial will be followed for an expected average of 12 months
The number of CEI ordered for patients at high CIN risk, divided by the total number of CEI orders. \[CEI\]: contrast-enhanced image studies,such as CT or IVU. \[CIN\]: contrast-induced nephropathy
Secondary Outcomes
- The order elimination rate of high CIN risk orders attributed to the computerized reminder(Physicains who participated in this trial will be followed for an expected average of 12 months)