Study design
CAD
REGRESSION, CAD
Each site randomized providers (physicians, physician assistants, and nurse practitioners) to the intervention or control arm, using a random number generator. Each provider had an equal probability of being assigned to either arm. Providers in the intervention arm received the alert during clinical encounters. The alert was generated and logged for providers in the control arm; however, the alert was not actually shown to the user.Immediately after study completion, we extracted data on alert firing, alert acceptance, and problem list utilization at each site. We compared the rate of alert acceptance using a chi-squared test and the rate of problem list addition using Poisson regression.At one site (MGB), we also evaluated the effect of the alert on clinical quality measures. This analysis was done by condition and compared patients for whom an alert was generated and displayed in the intervention arm to patients for whom an alert would have generated, but not displayed, in the control arm. This analysis was done on an intention to treat basis. For example, for the “LDL Testing” measure in the CAD condition, we calculated the proportion of patients with a low-density lipoprotein (LDL) test during the measurement period, compared across the control and intervention arms. Proportions for each quality measure were compared using a chi-squared test, with a Bonferroni correction for multiple comparisons.The study was registered with clinicaltrials.gov prior to patient accrual, trial identifier NCT02596087, and was approved by the institutional review boards of MGB, Holy Spirit Hospital, Oregon Health and Science University, and Vanderbilt University.