User Actions within a Clinical Decision Support Alert for the Management of Hypertension in Chronic Kidney Disease

Authors

• Lipika Samal
• Sarah W Chen
• Stuart Lipsitz
• Heather J Baer
• John L Kilgallon
• Michael Gannon
• Ryan Dunk
• Weng Ian Chay
• Richard Fay
• Michael Sainlaire
• Chenxi Gao
• Matthew Wien
• Pamela M Garabedian
• Edward Wu
• Hojjat Salmasian
• David W Bates
• Patricia C Dykes
• Adam Wright
• Allison B McCoy

Language

English

Publication Date

5-1-2025

Journal

10.1055/a-2554-3969

DOI

10.1055/a-2554-3969

PMID

40097147

PMCID

PMC12221691

PubMedCentral® Posted Date

7-2-2025

PubMedCentral® Full Text Version

Post-print

Abstract

This study aimed to examine user actions within a clinical decision support (CDS) alert addressing hypertension (HTN) in chronic kidney disease (CKD).A pragmatic randomized controlled trial of a CDS alert for primary care patients with CKD and uncontrolled blood pressure included prechecked default orders for medication initiation or titration, basic metabolic panel (BMP), and nephrology electronic consult (e-consult). We examined each type of action and calculated percentages of placed and signed orders for subgroups of firings.There were firings for medication initiation (813) and medication titration (430), and every firing also included orders for nephrology e-consult (1,243) and BMP (1,243). High rates of override (59.6%) and deferral (14.6%) were observed, and CDS-recommended orders were only signed about one-third of the time from within the alert. The percentage of orders that were signed after being placed within the alert was higher for medication initiation than for medication titration (33 vs. 12.0% for angiotensin-converting enzyme inhibitors [ACEi] and 38.8 vs. 14% for angiotensin II receptor blockers [ARBs]). Findings suggest that users are hesitant to commit to immediate action within the alert.Evaluating user interaction within alerts reveals nuances in physician preferences and workflow that should inform CDS alert design. This study is registered with the Clinicaltrials.gov Trial Registration (identifier: NCT03679247).

Keywords

Female, Humans, Male, Middle Aged, Decision Support Systems, Clinical, Hypertension, Renal Insufficiency, Chronic, clinical decision support, alert, override reasons, user actions, feedback

Published Open-Access

yes

Recommended Citation

Samal, Lipika; Chen, Sarah W; Lipsitz, Stuart; et al., "User Actions within a Clinical Decision Support Alert for the Management of Hypertension in Chronic Kidney Disease" (2025). Faculty, Staff and Students Publications. 8493.
https://digitalcommons.library.tmc.edu/baylor_docs/8493