Clinical Decision Support System: A Pragmatic Tool to Improve Acute Exacerbation of COPD Discharge Recommendations

Figures & data

Figure 1. The above EHR-based CDS tool was placed in the patient care workflow after confirmation of the AECOPD diagnosis and before completion of discharge medications and recommendations. The tool is launched automatically in the navigator menu. Once the physician selects one of the long-acting bronchodilators shown above then a menu with all of the relevant inhalers for that specific category is shown (e.g. “INH. Tiotropium bromide 2.5 mcg/puff 2-puffs OD”). The recommendations selected by the physician will automatically convert into prescriptions and written recommendations that will appear in the discharge letter.

Table 1. Baseline characteristics of hospital admissions for AECOPD, before and after the integration of the CDS tool into the EHR system.

		Before intervention (n = 536)	During intervention (n = 367)	p-value
Age	Median, interquartile range	70 (61–77)	69 (60–77)	0.13
	Mean ± SD	69.6 ± 11.1	68.4 ± 11.2
Sex (% males)		60.8%	67.9%	0.037
Charlson Index	Median, interquartile range	6.0 (4–9)	6.0 (4–9)	0.55
	Mean ± SD	6.6 ± 3.4	6.5 ± 3.6
Length of stay (days)	Median, interquartile range	4 (3–7)	4 (3–6)	0.97
	Mean ± SD	6.2 ± 7.8	5.4 ± 4.3
PCO2 on admission (mmHg)^a	Median, interquartile range	57.0 (49–71)	57.0 (48–72.5)	0.85
	Mean ± SD	61.4 ± 17.5	61.9 ± 18.6
PCO2 on discharge (mmHg)^b	Median, interquartile range	55.0 (47–64)	56.0 (48–67)	0.20
	Mean ± SD	57.0 ± 13.1	58.6 ± 14.3
Proportion of patients using long-acting inhalers before admission		36.8%	54.0%	<0.001

^a Information about pCO₂ level at admission was available for 97% of patients in the pre-intervention group and for 98% in the intervention group.

^b Information about pCO₂ level before discharge was available for 97% of patients in the pre-intervention group and for 85% in the intervention group.

Figure 2. Changes in adherence to guideline-based discharge recommendations before and after implementation of the CDS tool. All the differences are statistically significant p < 0.001.