Summary
Introduction: The identification of key factors influencing responses to prompts and reminders
within a computer decision support system (CDSS) has not been widely studied. The
aim of this study was to evaluate why clinicians routinely answer certain prompts
while others are ignored. Methods: We utilized data collected from a CDSS developed by our research group – the Child
Health Improvement through Computer Automation (CHICA) system. The main outcome of
interest was whether a clinician responded to a prompt.
Results: This study found that, as expected, some clinics and physicians were more likely
to address prompts than others. However, we also found clinicians are more likely
to address prompts for younger patients and when the prompts address more serious
issues. The most striking finding was that the position of a prompt was a significant
predictor of the likelihood of the prompt being addressed, even after controlling
for other factors. Prompts at the top of the page were significantly more likely to
be answered than the ones on the bottom.
Conclusions: This study detailed a number of factors that are associated with physicians following
clinical decision support prompts. This information could be instrumental in designing
better interventions and more successful clinical decision support systems in the
future.
Keywords
Clinical decision support systems - CHICA - screening - prompts - EMR
