A study of more than 788,000 patient visits in eight primary care clinics of Kaiser Permanente's health care system in Colorado found that real-time physician alerts reduced unnecessary use of a blood test used to help diagnosis blood clots in elderly patients.
The randomized trial of 223,877 visits by patients aged 65 or older, and 564,264 visits by patients under 65, was conducted because the overall accuracy of the test, called D-dimer, is only 35 percent for older patients. Physicians ordering the test for seniors via Kaiser's electronic health records system immediately received an alert explaining the inaccuracy of the test for this age group and suggesting that a radiological test be ordered instead.
Consequently, ordering of D-dimer tests for patients 65 and older fell 70 percent across the study area. "The results indicate that computerized alerts containing alternative diagnostic or treatment strategies to direct clinicians toward more appropriate alternative diagnostic strategies can be more effective in practice than simply providing 'negative guidance,'" according to the study.
The study was published Nov. 5 in the American Journal of Managed Care.
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