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

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

Research output: Contribution to journalArticle

2 Citations (Scopus)

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

Fingerprint

Colonoscopy
Safety
Electronic Health Records
Patient Satisfaction
Patient Preference
Gastroenterology
Ambulatory Care
Endoscopy
Nurses
Physicians
sodium phosphate

Keywords

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

ASJC Scopus subject areas

  • Health Informatics

Cite this

Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation. / Imperiale, Thomas; Sherer, Eric A.; Balph, Jo Ann D; Cardwell, Jon D.; Qi, Rong.

In: International Journal of Medical Informatics, Vol. 80, No. 10, 10.2011, p. 726-733.

Research output: Contribution to journalArticle

Imperiale, Thomas ; Sherer, Eric A. ; Balph, Jo Ann D ; Cardwell, Jon D. ; Qi, Rong. / Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation. In: International Journal of Medical Informatics. 2011 ; Vol. 80, No. 10. pp. 726-733.
@article{222ff1b5b0844efd9b74daba7b69627e,
title = "Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation",
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.",
keywords = "Clinical, Colonoscopy, Decision support systems, Efficiency, Organizational",
author = "Thomas Imperiale and Sherer, {Eric A.} and Balph, {Jo Ann D} and Cardwell, {Jon D.} and Rong Qi",
year = "2011",
month = "10",
doi = "10.1016/j.ijmedinf.2011.07.001",
language = "English",
volume = "80",
pages = "726--733",
journal = "International Journal of Medical Informatics",
issn = "1386-5056",
publisher = "Elsevier Ireland Ltd",
number = "10",

}

TY - JOUR

T1 - Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation

AU - Imperiale, Thomas

AU - Sherer, Eric A.

AU - Balph, Jo Ann D

AU - Cardwell, Jon D.

AU - Qi, Rong

PY - 2011/10

Y1 - 2011/10

N2 - 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.

AB - 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.

KW - Clinical

KW - Colonoscopy

KW - Decision support systems

KW - Efficiency

KW - Organizational

UR - http://www.scopus.com/inward/record.url?scp=80052795067&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052795067&partnerID=8YFLogxK

U2 - 10.1016/j.ijmedinf.2011.07.001

DO - 10.1016/j.ijmedinf.2011.07.001

M3 - Article

VL - 80

SP - 726

EP - 733

JO - International Journal of Medical Informatics

JF - International Journal of Medical Informatics

SN - 1386-5056

IS - 10

ER -