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Physician Alert Decreases D-Dimer Testing in Elderly

Immediate notification of rate of false positives changes physicians' diagnostic test choice

MONDAY, Nov. 8 (HealthDay News) -- An automatic electronic message sent to physicians immediately after they order a possibly inappropriate D-dimer blood test for elderly patients decreases the use of that test, according to research published online Nov. 4 in the American Journal of Managed Care.

Ted E. Palen, M.D., of the Colorado Permanente Medical Group in Denver, and colleagues conducted a randomized trial of 223,877 patient visits for patients 65 years of age and over, and 564,264 patient visits for patients under 65 years of age, at primary care clinics in which the electronic notification system had been implemented. The purpose of the study was to determine if inappropriate use of D-dimer testing -- which has an accuracy of only 35 percent in those aged 65 and over -- could be reduced by real-time electronic notifications of this fact to ordering physicians.

The researchers found that D-dimer tests among patients aged 65 and older fell from 5.02 to 1.52 per 1,000 patient visits and remained at this level throughout the study period. The ratio of venous extremity ultrasound tests/completed D-dimer tests increased from 1.17 to 4.05 (P < 0.001) and 2.25 to 7.29 (P < 0.001) in the intervention and control clinics, respectively, after the system was activated in all clinics.

"As electronic medical record technology improves, it might be possible in the future to tailor alert messages to clinicians based on their practice patterns, so that each clinician only receives alerts in areas where their individual practice could benefit. Systems might also be able to 'remove' alerts for individual clinicians who have demonstrated persistent improvement in ordering practices. Hopefully, these approaches will mitigate the possibility of alert overload and minimize the possibility of clinicians disregarding alert messages," the authors write.

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