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Computerized clinical decision support system for diabetes in primary care does not improve quality of care: a cluster-randomized controlled trial

Overview of attention for article published in Implementation Science, January 2020
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  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (76th percentile)

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Title
Computerized clinical decision support system for diabetes in primary care does not improve quality of care: a cluster-randomized controlled trial
Published in
Implementation Science, January 2020
DOI 10.1186/s13012-019-0955-6
Pubmed ID
Authors

Annemie Heselmans, Nicolas Delvaux, Annouschka Laenen, Stijn Van de Velde, Dirk Ramaekers, Ilkka Kunnamo, Bert Aertgeerts

Abstract

The EBMeDS system is the computerized clinical decision support (CCDS) system of EBPNet, a national computerized point-of-care information service in Belgium. There is no clear evidence of more complex CCDS systems to manage chronic diseases in primary care practices (PCPs). The objective of this study was to assess the effectiveness of EBMeDS use in improving diabetes care. A cluster-randomized trial with before-and-after measurements was performed in Belgian PCPs over 1 year, from May 2017 to May 2018. We randomly assigned 51 practices to either the intervention group (IG), to receive the EBMeDS system, or to the control group (CG), to receive usual care. Primary and secondary outcomes were the 1-year pre- to post-implementation change in HbA1c, LDL cholesterol, and systolic and diastolic blood pressure. Composite patient and process scores were calculated. A process evaluation was added to the analysis. Results were analyzed at 6 and 12 months. Linear mixed models and logistic regression models based on generalized estimating equations were used where appropriate. Of the 51 PCPs that were enrolled and randomly assigned (26 PCPs in the CG and 25 in the IG), 29 practices (3815 patients) were analyzed in the study: 2464 patients in the CG and 1351 patients in the IG. No change differences existed between groups in primary or secondary outcomes. Change difference between CG and IG after 1-year follow-up was - 0.09 (95% CI - 0.18; 0.01, p-value = 0.06) for HbA1c; 1.76 (95% CI - 0.46; 3.98, p-value = 0.12) for LDL cholesterol; and 0.13 (95% CI - 0.91; 1.16, p-value = 0.81) and 0.12 (95% CI - 1.25;1.49, p-value = 0.86) for systolic and diastolic blood pressure respectively. The odds ratio of the IG versus the CG for the probability of no worsening and improvement was 1.09 (95% CI 0.73; 1.63, p-value = 0.67) for the process composite score and 0.74 (95% CI 0.49; 1.12, p-value = 0.16) for the composite patient score. All but one physician was satisfied with the EBMeDS system. The CCDS system EBMeDS did not improve diabetes care in Belgian primary care. The lack of improvement was mainly caused by imperfections in the organizational context of Belgian primary care for chronic disease management and shortcomings in the system requirements for the correct use of the EBMeDS system (e.g., complete structured records). These shortcomings probably caused low-use rates of the system. ClinicalTrials.gov, NCT01830569, Registered 12 April 2013.

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X Demographics

The data shown below were collected from the profiles of 11 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 141 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 141 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 14 10%
Researcher 13 9%
Student > Bachelor 13 9%
Student > Ph. D. Student 12 9%
Other 7 5%
Other 17 12%
Unknown 65 46%
Readers by discipline Count As %
Medicine and Dentistry 24 17%
Nursing and Health Professions 11 8%
Computer Science 9 6%
Biochemistry, Genetics and Molecular Biology 6 4%
Pharmacology, Toxicology and Pharmaceutical Science 4 3%
Other 15 11%
Unknown 72 51%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 7. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 July 2020.
All research outputs
#4,522,434
of 23,186,937 outputs
Outputs from Implementation Science
#861
of 1,726 outputs
Outputs of similar age
#105,618
of 456,495 outputs
Outputs of similar age from Implementation Science
#17
of 24 outputs
Altmetric has tracked 23,186,937 research outputs across all sources so far. Compared to these this one has done well and is in the 80th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,726 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 14.8. This one is in the 49th percentile – i.e., 49% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 456,495 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 76% of its contemporaries.
We're also able to compare this research output to 24 others from the same source and published within six weeks on either side of this one. This one is in the 29th percentile – i.e., 29% of its contemporaries scored the same or lower than it.