Table 3.
Multivariate analysis results for factors associated with primary care providers’ subsequent action following opening of noninterruptive alerts. Alerts were opened by the addressed primary care provider, staff, or provider other than the addressed primary care provider. The primary care provider’s actions in the electronic health record related to the relevant patient were tracked over the day of alert opening and the following day.
| Characteristics of alerts, physicians, patients, and contextual factors | Total alerts | General actiona in electronic health record taken by PCPb | Medication-specific actionc taken by PCP | Laboratory-specific actiond taken by PCP | ||||||||||||
| N (%) | Action is taken, N (%) | AORe (95% CI) | Action is taken, N (%) | AOR (95% CI) | Action is taken, N (%) | AOR (95% CI) | ||||||||||
| Total | 799 | 538 (67.3) | N/Af | 154 (19.3) | N/A | 180 (22.5) | N/A | |||||||||
| Alert type | ||||||||||||||||
| Information only | 593 (74.2) | 382 (71) | Reference | 95 (61.7) | Reference | 100 (55.6) | Reference | |||||||||
| Medication recommendationg | 37 (4.6) | 29 (5.4) | 2.0 (0.9- 4.8) | 18 (11.7) | 5.6 (2.4- 12.9) | 20 (11.1) | 7.4 (3.6- 15.0) | |||||||||
| Test recommendationh | 169 (21.2) | 127 (23.6) | 1.7 (1.1- 2.5) | 41 (26.6) | 1.7 (1.1- 2.7) | 60 (33.3) | 2.8 (1.7- 4.4) | |||||||||
| Time to alert opening | ||||||||||||||||
| Opened ≤24 h after delivery | 472 (59.1) | 308 (57.2) | Reference | 88 (57.1) | Reference | 101 (56.1) | Reference | |||||||||
| Opened >24 h and ≤48 h after delivery | 137 (17.1) | 97 (18) | 1.2 (0.6- 2.4) | 27 (17.5) | 1.2 (0.7- 1.9) | 28 (15.6) | 1.1 (0.6- 2.0) | |||||||||
| Opened >48 h after delivery | 190 (23.8) | 133 (24.7) | 1.2 (0.7- 2.2) | 39 (25.3) | 1.1 (0.6- 1.8) | 51 (28.3) | 1.4 (0.8- 2.4) | |||||||||
| Opened by PCP/other staff | ||||||||||||||||
| Opened by staff/provider other than PCP | 172 (21.5) | 100 (18.6) | Reference | 17 (11) | Reference | 23 (12.8) | Reference | |||||||||
| Opened by PCP | 627 (78.5) | 438 (81.4) | 1.4 (0.8-2.5) | 137 (89) | 2.1 (1.4-3.4) | 157 (87.2) | 1.7 (1.0-2.7) | |||||||||
| PCP characteristics | ||||||||||||||||
| Age | ||||||||||||||||
| <50 years | 296 (37.0) | 203 (37.7) | Reference | 63 (40.9) | Reference | 80 (44.4) | Reference | |||||||||
| ≥50 years | 503 (63.0) | 335 (62.3) | 1.0 (0.7- 1.4) | 91 (59.1) | 0.6 (0.4- 1.1) | 100 (55.6) | 0.6 (0.4- 0.9) | |||||||||
| Gender | ||||||||||||||||
| Female | 264 (33.0) | 182 (33.8) | Reference | 54 (35.1) | Reference | 71 (39.4) | Reference | |||||||||
| Male | 535 (67.0) | 356 (66.2) | 0.6 (0.4- 1.0) | 100 (64.9) | 0.7 (0.4- 1.3) | 109 (60.6) | 0.5 (0.3- 0.7) | |||||||||
| Number of patient encounters in study year (quartiles)i | ||||||||||||||||
| >0 and ≤2326 | 80 (10.0) | 58 (10.8) | Reference | 8 (5.2) | Reference | 14 (7.8) | Reference | |||||||||
| >2326 and ≤2783 | 163 (20.4) | 94 (17.5) | 0.6 (0.3- 1.4) | 18 (11.7) | 0.5 (0.4- 2.8) | 30 (16.7) | 1.0 (0.4- 2.2) | |||||||||
| >2783 and ≤3173 | 247 (30.9) | 168 (31.2) | 1.0 (0.5- 2.1) | 54 (35.1) | 1.5 (1.2- 8.0) | 59 (32.8) | 1.9 (0.9- 4.0) | |||||||||
| >3173 | 309 (38.7) | 218 (40.5) | 1.5 (0.7- 3.3) | 74 (48.1) | 2.5 (1.5- 13.3) | 77 (42.8) | 2.7 (1.3- 5.8) | |||||||||
| Specialty | ||||||||||||||||
| Internal medicine | 118 (14.8) | 445 (82.7) | Reference | 129 (83.8) | Reference | 155 (86.1) | Reference | |||||||||
| Family medicine | 661 (82.7) | 79 (14.7) | 0.7 (0.4- 1.2) | 22 (14.3) | 0.9 (0.4- 1.8) | 20 (11.1) | 0.6 (0.4- 0.9) | |||||||||
| Non-MDj PCP | 11 (1.4) | 6 (1.1) | 0.3 (0.1- 1.2) | 2 (1.3) | 0.6 (0.2- 1.9) | 3 (1.7) | 0.6 (0.3- 1.4) | |||||||||
| Subspecialty | 9 (1.1) | 8 (1.5) | 3.0 (1.0- 9.6) | 1 (0.6) | 1.4 (0.4- 5.3) | 2 (1.1) | 2.1 (0.7- 6.0) | |||||||||
| Patient characteristics | ||||||||||||||||
| Age | ||||||||||||||||
| 65-74 years | 255 (31.9) | 171 (31.8) | Reference | 55 (35.7) | Reference | 56 (31.1) | Reference | |||||||||
| 75-84 years | 349 (43.7) | 241 (44.8) | 1.1 (0.7- 1.6) | 57 (37) | 0.8 (0.5- 1.1) | 77 (42.8) | 1.0 (0.6- 1.4) | |||||||||
| ≥85 years | 195 (24.4) | 126 (23.4) | 0.9 (0.5- 1.4) | 42 (27.3) | 1.0 (0.6- 1.5) | 47 (26.1) | 1.0 (0.6- 1.6) | |||||||||
| Gender | ||||||||||||||||
| Female | 418 (52.3) | 284 (52.8) | Reference | 81 (52.6) | Reference | 93 (51.7) | Reference | |||||||||
| Male | 381 (47.7) | 254 (47.2) | 0.9 (0.7- 1.3) | 73 (47.4) | 1.1 (0.8- 1.6) | 87 (48.3) | 1.3 (0.9- 1.8) | |||||||||
| Number of office visits in the previous 12 months | ||||||||||||||||
| ≤6 visits | 205 (25.7) | 125 (23.2) | Reference | 41 (26.6) | Reference | 39 (21.7) | Reference | |||||||||
| >6 and ≤11 visits | 219 (27.4) | 142 (26.4) | 1.3 (0.9- 2.0) | 36 (23.4) | 0.9 (0.5- 1.6) | 44 (24.4) | 1.0 (0.6- 1.7) | |||||||||
| >11 and ≤18 visits | 194 (24.3) | 144 (26.8) | 2.1 (1.3- 3.6) | 42 (27.3) | 1.4 (0.8- 2.3) | 48 (26.7) | 1.4 (0.6- 1.7) | |||||||||
| >18 visits | 181 (22.7) | 127 (23.6) | 1.7 (1.0- 2.7) | 35 (22.7) | 1.2 (0.6- 2.1) | 49 (27.2) | 1.5 (0.9- 2.5) | |||||||||
| Charlson comorbidity score | ||||||||||||||||
| 0 | 78 (9.8) | 51 (9.5) | Reference | 17 (11) | Reference | 11 (6.1) | Reference | |||||||||
| 1 | 92 (11.5) | 56 (10.4) | 0.7 (0.3- 1.4) | 16 (10.4) | 0.7 (0.3- 1.7) | 17 (9.4) | 1.3 (0.5- 3.1) | |||||||||
| 2 | 118 (14.8) | 80 (14.9) | 0.9 (0.4- 1.8) | 21 (13.6) | 0.7 (0.3- 1.6) | 25 (13.9) | 1.6 (0.6- 3.9) | |||||||||
| ≥3 | 511 (64.0) | 351 (65.2) | 0.8 (0.4- 1.4) | 100 (64.9) | 0.6 (0.3- 1.3) | 127 (70.6) | 1.3 (0.6- 2.8) | |||||||||
| Length of stay | ||||||||||||||||
| ≤2 days | 360 (45.1) | 229 (42.6) | Reference | 65 (42.2) | Reference | 74 (41.1) | Reference | |||||||||
| 3 days | 281 (35.2) | 199 (37) | 1.4 (1.0- 2.1) | 57 (37) | 1.1 (0.8- 1.6) | 67 (37.2) | 1.2 (0.9- 1.7) | |||||||||
| ≥4 days | 158 (19.8) | 110 (20.4) | 1.5 (0.9- 2.5) | 32 (20.8) | 1.3 (0.8- 2.1) | 39 (21.7) | 1.5 (0.9- 2.4) | |||||||||
| Contextual factors | ||||||||||||||||
| Total number of notifications in InBasket at the time of alert delivery | ||||||||||||||||
| ≤42 | 207 (25.9) | 146 (27.1) | Reference | 43 (27.9) | Reference | 51 (28.3) | Reference | |||||||||
| >42 and ≤69 | 194 (24.3) | 134 (24.9) | 0.9 (0.5- 1.5) | 32 (20.8) | 0.9 (0.5- 1.5) | 34 (18.9) | 0.7 (0.5- 1.1) | |||||||||
| >69 and ≤157 | 199 (24.9) | 135 (25.1) | 0.7 (0.4- 1.2) | 37 (24) | 1.0 (0.6- 1.8) | 51 (28.3) | 1.4 (0.9- 2.0) | |||||||||
| >157 | 199 (24.9) | 123 (22.9) | 0.5 (0.3-1.0) | 42 (27.3) | 1.0 (0.7- 2.4) | 44 (24.4) | 0.9 (0.6- 1.5) | |||||||||
| Number of unopened notifications in InBasket at the time of alert delivery | ||||||||||||||||
| ≤0 | 251 (31.4) | 165 (30.7) | Reference | 50 (32.5) | Reference | 57 (31.7) | Reference | |||||||||
| >0 and ≤4 | 183 (22.9) | 122 (22.7) | 1.0 (0.7- 1.5) | 34 (22.1) | 0.8 (0.5-1.3) | 42 (23.3) | 0.9 (0.6- 1.5) | |||||||||
| >4 and ≤9 | 185 (23.2) | 127 (23.6) | 1.2 (0.7- 2.0) | 32 (20.8) | 0.7 (0.5- 1.0) | 45 (25) | 0.8 (0.5- 1.4) | |||||||||
| >9 | 180 (22.5) | 124 (23) | 1.5 (0.9- 2.5) | 38 (24.7) | 1.2 (0.8- 1.8) | 36 (20) | 0.8 (0.5- 1.2) | |||||||||
| Notification count in the week prior to alert delivery | ||||||||||||||||
| ≤344 | 200 (25.0) | 146 (27.1) | Reference | 39 (25.3) | Reference | 55 (30.6) | Reference | |||||||||
| >344 and ≤453 | 201 (25.2) | 127 (23.6) | 0.7 (0.4- 1.0) | 43 (27.9) | 0.9 (0.6- 1.4) | 49 (27.2) | 0.6 (0.4- 1.1) | |||||||||
| >453 and ≤546 | 199 (24.9) | 135 (25.1) | 0.7 (0.5- 1.1) | 35 (22.7) | 0.6 (0.4- 0.9) | 35 (19.4) | 0.4 (0.3- 0.8) | |||||||||
| >546 | 199 (24.9) | 130 (24.2) | 0.7 (0.4- 1.1) | 37 (24) | 0.6 (0.4- 1.0) | 41 (22.8) | 0.6 (0.4- 1.0) | |||||||||
| Day of the week alert sent | ||||||||||||||||
| All other days | 633 (79.2) | 418 (77.7) | Reference | 119 (77.3) | Reference | 143 (79.4) | Reference | |||||||||
| Saturday | 166 (20.8) | 120 (22.3) | 1.3 (0.7- 2.2) | 35 (22.7) | 1.2 (0.7- 1.9) | 37 (20.6) | 0.9 (0.6- 1.6) | |||||||||
aGeneral Action in electronic health record includes opening a section of the electronic medical record (medications, laboratory, orders, results, encounters, demographic information, other clinical information, nonclinical information, and information entry) or choosing one of several options on the alert that served as direct links to summaries of components of that patient’s record.
bMedication-specific action includes medication list viewing and ordering.
cLaboratory-specific action includes laboratory viewing and ordering.
dPCP: primary care physician.
eAOR: adjusted odds ratio.
fN/A: not applicable.
gMedication recommendations were automated electronic health record InBasket alerts that contained warnings about interactions or recommendations for dose changes.
hTest recommendations were automated electronic health record InBasket alerts identifying the need for laboratory monitoring for high-risk medications.
iWe categorized the total number of patient encounters for each physician during the year prior to alert delivery in quartiles across the 75 primary care physicians to whom alerts were sent to approximate full- vs part-time status.
jMD: doctor of medicine.