Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation

Thomas F. Imperiale, Eric A. Sherer, Jo Ann D. Balph, Jon D. Cardwell, Rong Qi

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Purpose: To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, or repeated sooner than recommended due to preparation (prep) quality; prep quality; colonoscopy duration; and patient satisfaction with and tolerance of the preparation. Methods: We used 4 alternating 4-week periods to compare the decision tool with usual care for outpatient colonoscopy. All decision tool decisions were reviewed in real-time by gastroenterology nurses and/or physicians. Patients completed a survey about the prep process. Endoscopists blindly rated prep quality. Colonoscopy duration and findings were recorded. Results: Of 354 persons in the decision tool group, 4 prep decisions were overridden because of patient preference or prior prep failure, but none for medical reasons. Sodium phosphate was used more frequently in the decision tool group (73% vs. 41%; P<0.01). There was no difference between the decision tool and usual care groups in the composite outcome (26% vs. 30%, respectively; P=0.29), acceptable prep quality (62% vs. 56%; P=0.22), colonoscopy duration (28 vs. 30. min; P=0.17), patient satisfaction (P=0.38), or preparation tolerance (P=0.37). Conclusions: An electronic medical record-based decision tool can safely and effectively tailor the prep for colonoscopy and may improve colonoscopy efficiency and patient satisfaction. Limitations: This study was performed at a single VA medical center and endoscopy unit, relies on the presence of relevant medical conditions and laboratory data in the electronic medical record, and had a higher than expected use of sodium phosphate during usual care.

Original languageEnglish (US)
Pages (from-to)726-733
Number of pages8
JournalInternational Journal of Medical Informatics
Volume80
Issue number10
DOIs
StatePublished - Oct 1 2011

Keywords

  • Clinical
  • Colonoscopy
  • Decision support systems
  • Efficiency
  • Organizational

ASJC Scopus subject areas

  • Health Informatics

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