DOES COLOR-HIGHLIGHTING CLINICAL DECISION SUPPORT REMINDERS IMPROVE PHYSICIANS' RESPONSIVENESS?

Purpose: Physicians respond to only approximately half of the clinical decision support prompts they receive, and alert fatigue has been offered as an explanation for this lack of responsiveness. This study tested the hypothesis that selectively color-highlighting prompts would increase physicians' rates of responsiveness.

Method: We conducted a randomized controlled trial using the Child Health Improvement through Computer Automation (CHICA) system. CHICA is a clinical decision support system implemented in four primary care pediatric clinics in Indianapolis, IN. It provides physicians with reminder prompts which are algorithmically derived and based on: 1) general pediatric healthcare guidelines and 2) responses parents provide about their children on a pre-visit screening form. Physicians place a check-mark in a box next to each prompt to indicate whether they responded to it. We selected eight prompts for randomization. Four of these prompts were yellow-highlighted when presented to physicians in two of the clinics. The other four prompts were yellow-highlighted when presented to physicians in the remaining two clinics. Each of the pairs of clinics served as the other pair's control. Analyses compared physician response rates to the highlighted versus non-highlighted prompts. Additionally, four prompts deemed “high-priority” (e.g., household violence) were yellow-highlighted during the study period at all of the four clinic sites. Physician response rates to these high-priority highlighted prompts were compared to response rates for those same prompts during the year before the study period, when they were not highlighted. Data analyses included binary logistic regression and chi-square analysis, including Bonferroni corrections for multiple comparisons.

Result: There was no difference in physicians’ response rates to highlighted compared to non-highlighted prompts (OR=1.056, p=0.259, ns). Similarly, physicians were no more likely to respond to highlighted high-priority prompts, compared to the previous year when the prompts were not highlighted (χ²=0.067, p=0.796, ns).

Conclusion: We did not find evidence that yellow-highlighting clinical decisions support reminders is an effective strategy to increase physician responsiveness. Alternative possibilities for combating alert-fatigue and increasing responsiveness to prompts should be explored.