Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Ambulatory Care Information Systems; Anti-Inflammatory Agents, Non-Steroidal; *Computers, Handheld; *Decision Support Systems, Clinical; *Drug Therapy, Computer-Assisted; Gastrointestinal Diseases; Hospitals, University; Humans; Medication Errors; Outpatient Clinics, Hospital; *Point-of-Care Systems; Risk Assessment; Risk Factors


Bioinformatics | Biostatistics | Epidemiology | Health Services Research


OBJECTIVE: To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system (CDSS) on nonsteroidal anti-inflammatory drug (NSAID) prescribing safety in the outpatient setting.

DESIGN: The design was a randomized, controlled trial conducted in a university-based resident clinic. Internal medicine residents received a PDA-based CDSS suite. For intervention residents, the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations. Unannounced standardized patients (SPs) trained to portray musculoskeletal symptoms presented to study physicians. Safety outcomes were assessed from the prescriptions given to the SPs. Each prescription was reviewed by a committee of clinicians blinded to participant, intervention group assignment, and baseline or follow-up status.

MEASUREMENTS: Prescriptions were judged as safe or unsafe. The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group.

RESULTS: At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p > 0.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS (0.23 vs. 0.45 [F = 4.24, p < 0.05]). With the CDSS, intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs.

CONCLUSION: PARTICIPANTS provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS.

DOI of Published Version



J Am Med Inform Assoc. 2006 Mar-Apr;13(2):171-9. Epub 2005 Dec 15. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American Medical Informatics Association : JAMIA

PubMed ID


Related Resources

Link to Article in PubMed