Cluster randomized controlled trial of TIA electronic decision support in primary care

Neurology
Annemarei RantaMurray Tilyard

Abstract

To test if TIA/stroke electronic decision support in primary care improves management. Multicenter, single-blind, parallel-group, cluster randomized, controlled trial comparing TIA/stroke electronic decision support guided management with usual care. Main outcomes were guideline adherence and 90-day stroke risk. Secondary outcomes were cerebrovascular/vascular/death/adverse events, cost, and user feedback. Main analysis was logistic regression with a normal random effect for clusters using a generalized linear mixed model. Twenty-nine clinics were randomized to intervention, 27 to control, recruiting 172 and 119 eligible patients. More intervention patients received guideline-adherent care (131/172; 76.2%) than control patients (49/119; 41.2%) (adjusted odds ratio [OR] 4.57; 95% confidence interval [CI] 2.39-8.71; p < 0.001). Ninety-day stroke occurred in 2/172 (1.2%) intervention and 5/119 (4.2%) control patients (OR 0.27; 95% CI 0.05-1.41; p = 0.098). Ninety-day TIA or stroke occurrence was lower in the intervention group, 4/172 (2.3%) compared to 10/119 (8.5%) control (adjusted OR 0.26; 95% CI 0.70-0.97; p = 0.045). Fewer vascular events/deaths occurred in intervention, 6/172 (3.5%), than in control patients, 14/119 (11.9%) ...Continue Reading

Citations

Jan 24, 2016·Neurology·Annemarei Ranta, P Alan Barber
Jan 24, 2016·Neurology·James F Burke, Mollie McDermott
Jun 2, 2016·Journal of Women's Health·Seemant ChaturvediMary Beth Lepczyk
Oct 16, 2016·Emergency Medicine Clinics of North America·Andrea Duca, Andy Jagoda
Mar 14, 2018·Journal of Primary Health Care·Priyanka BoseAmit Mistri
Jul 30, 2016·Stroke; a Journal of Cerebral Circulation·P Alan BarberUNKNOWN ARCOS IV Study Group
Jul 12, 2020·Clinical Trials : Journal of the Society for Clinical Trials·Peter J GodolphinAlan A Montgomery
Apr 13, 2017·The Cochrane Database of Systematic Reviews·Dawn StaceyLyndal Trevena
May 8, 2018·The Cochrane Database of Systematic Reviews·Bernadeta BridgwoodPriya Modi
Jul 30, 2020·BMJ Health & Care Informatics·John FoxJohn Bechtel
May 29, 2018·Journal of Medical Internet Research·Mark J RapoportGary Naglie
Aug 1, 2019·Stroke; a Journal of Cerebral Circulation·Peter J GodolphinUNKNOWN Adjudicating Outcomes in Stroke Trials Collaboration
Oct 16, 2020·The Cochrane Database of Systematic Reviews·Liana S CahillDenise O'Connor
Jul 20, 2021·Journal of the American Medical Informatics Association : JAMIA·Viralkumar VaghaniHardeep Singh

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