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The Effect of a Clinical Decision Support System on Improving Adherence to Guideline in the Treatment of Atrial Fibrillation: An Interrupted Time Series Study

  • Mobile & Wireless Health
  • Published:
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Abstract

To evaluate the effect of a computerized Decision Support System (CDSS) on improving adherence to an anticoagulation guideline for the treatment of atrial fibrillation (AF). This study had an interrupted time series design. The adherence to the guideline was assessed at fortnightly (two weeks) intervals from January 2016 to January 2017, 6 months before and 6 months after intervention. Newly diagnosed patients with AF were included in the offices of ten cardiologists. Stroke and major bleeding risks were calculated by the CDSS which was implemented via a mobile application. Treatment recommendations based on the guideline were shown to cardiologists. The segmented regression model was used to evaluate the effect of CDSS on level and trend of guideline adherence for the treatment of AF. In our analysis, 373 patients were included. The trend of adherence to the anticoagulation guideline for the treatment of AF was stable in the pre-intervention phase. After the CDSS intervention, mean of the adherence to the guideline significantly increased from 48% to 65.5% (P-value < 0.0001). The trend of adherence to the guideline was stable in the post-intervention phase. Our results showed that the CDSS can improve adherence to the anticoagulation guideline for the treatment of AF. Registration ID: IRCT2016052528070N1.

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Funding

This study was funded by Mashhad University of Medical Sciences (thesis number 940843).

Author information

Authors and Affiliations

  1. Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Reza Sheibani & Saeid Eslami

  2. Department of Computer Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran

    Reza Sheibani

  3. Cardiovascular Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran

    Mehdi Sheibani

  4. Cardiovascular Research Center, Mashhad University of Medical Science, Mashhad, Iran

    Alireza Heidari-Bakavoli

  5. Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Ameen Abu-Hanna & Saeid Eslami

  6. Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Saeid Eslami

Authors
  1. Reza Sheibani
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  2. Mehdi Sheibani
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  3. Alireza Heidari-Bakavoli
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  4. Ameen Abu-Hanna
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  5. Saeid Eslami
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Contributions

SE, AH: conception and design of study, interpretation of data, and supervising the study. RS: software development, data collection, analysis and interpretation, and drafting manuscript. MS: data collection and interpretation, and critical revision. AA: conception and design, and critical revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Saeid Eslami.

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Conflict of interest

Authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Medical Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.fm.REC.1394.524). All procedures performed in the study were in accordance with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all cardiologists included in the study. Cardiologists’ information which must be considered as sensitive was not disclosed.

Additional information

This article is part of the Topical Collection on Mobile & Wireless Health

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Sheibani, R., Sheibani, M., Heidari-Bakavoli, A. et al. The Effect of a Clinical Decision Support System on Improving Adherence to Guideline in the Treatment of Atrial Fibrillation: An Interrupted Time Series Study. J Med Syst 42, 26 (2018). https://doi.org/10.1007/s10916-017-0881-6

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  • DOI: https://doi.org/10.1007/s10916-017-0881-6

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