Implementation of clinical decision support system for anticoagulant prescribing for patients with deep vein thrombosis

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  • Authors: Chernov A.A.1,2, Kleymenova E.B.1,2,3, Sychev D.A.2, Yashina L.P.1, Nigmatkulova M.D.1, Otdelenov V.A.1,2, Yashina L.P.1
  • Affiliations:
    1. General Medical Center of the Bank of Russia
    2. Russian Medical Academy of Continuing Professional Education
    3. Federal Research Center «Computer Science and Control» of the Russian Academy of Sciences
  • Issue: Vol 75, No 1 (2020)
  • Pages: 69-76
  • Section: HEALTH CARE MANAGEMENT: CURRENT ISSUES
  • URL: https://vestnikramn.spr-journal.ru/jour/article/view/1252
  • DOI: https://doi.org/10.15690/vramn1252
  • Cite item
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Abstract


Background: Physician’s adherence to recommendations for appropriate antithrombotic therapy of venous thromboembolism (VTE) can reduce the risk of recurrent VTE, pulmonary hypertension, bleeding and other adverse events. Clinical decision support systems (CDSS) are shown to increase physician’s adherence to clinical guidelines.

Aims: To assess effectivenes and safety of CDSS for anticoagulant prescribing for inhospital patients with VTE.

Methods: A prospective cohort study was conducted in a Moscow general hospital from 06.30.2017 to 06.23.2018 to compare physician’s compliance with clinical guidelines for DVT anticoagulant therapy, the rate of drug errors and direct costs of anticoagulant therapy before and after CDSS implementation (55 patients in control group and 49 in experimental group).

Results: The rate of anticoagulant prescribing for patients with DVT did not alter significantly after CDSS implementation (96% compared with 91% before CDSS), but physicians’ compliance with recommendations on anticoagulant dosage increased from 32.7% to 73.5% (p = 0.0003) with corresponding decrease in the rate of anticoagulant prescribing errors from 1.35 to 0.65 per 1 patient (p = 0.0005). The length of stay and hemorrhagic complication rate did not differ between control and experimental groups. LMWH replacement with new oral anticoagulants has reduced the cost of anticoagulant therapy for 1 patient from 11.800 rubles (IQR = 7000) to 5.430 rubles (IQR = 5700) (p < 0.005).

Conclusions: СDSS can increase physician’s adherence to recommended anticoagulant therapy for patients with DVT: to prevent unreasonable under-/overdosing or prolongation of anticoagulant therapy. CDSS for DVT drug therapy can be economically feasible.


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About the authors

Anton A. Chernov

General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education

Author for correspondence.
Email: sbornaya1med@yandex.ru
ORCID iD: 0000-0001-6209-387X
SPIN-code: 5893-5394

Russian Federation, 66, Sevastopolskii ave., Moscow, 117647; 2/1, Barrikadnaya st., Moscow, 125993

E. B. Kleymenova

General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education; Federal Research Center «Computer Science and Control» of the Russian Academy of Sciences

Email: e.kleymenova@gmail.com
ORCID iD: 0000-0002-8745-6195
SPIN-code: 2037-7164

Russian Federation, 66, Sevastopolskii ave., Moscow, 117647; 2/1, Barrikadnaya st., Moscow, 125993; 44-2, Vavilova str., Moscow, 119333

MD, PhD

Dmitry A. Sychev

Russian Medical Academy of Continuing Professional Education

Email: dmitrysychevrmapo@gmail.com
ORCID iD: 0000-0002-4496-3680
SPIN-code: 4525-7556

Russian Federation, 2/1, Barrikadnaya st., Moscow, 125993

MD, PhD, Professor

Liubov P. Yashina

General Medical Center of the Bank of Russia

Email: lyashina1@yandex.ru
ORCID iD: 0000-0003-1357-0056
SPIN-code: 1910-0484

Russian Federation, 66, Sevastopolskii ave., Moscow, 117647

PhD

Maria D. Nigmatkulova

General Medical Center of the Bank of Russia

Email: evagrigor@yandex.ru
ORCID iD: 0000-0001-8840-4904
SPIN-code: 2263-3980

Russian Federation, 66, Sevastopolskii ave., Moscow, 117647

Vitaly A. Otdelenov

General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education

Email: vitotd@ya.ru
ORCID iD: 0000-0003-0623-7263
SPIN-code: 8357-5770

Russian Federation, 117647, г. Москва, Севастопольский пр., 66; 125993, г. Москва ул. Баррикадная, д.2/1, стр.1

MD, PhD

L. P. Yashina

General Medical Center of the Bank of Russia

Email: svetlanapay@gmail.com
ORCID iD: 0000-0002-7350-0423
SPIN-code: 1367-6633

Russian Federation, 117647, г. Москва, Севастопольский пр., 66

PhD

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Supplementary files

Supplementary Files Action
1.
Fig. 1. The structure of prescribing anticoagulants to patients with deep vein thrombosis before the introduction of an automated decision support system

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2.
Fig. 2. The structure of prescribing anticoagulants to patients with deep vein thrombosis after the introduction of an automated decision support system

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