Cluster-randomized, controlled trial of computer-based decision support for selecting long-term anti-thrombotic therapy after acute ischaemic stroke.

摘要: Background Identifying the appropriate long-term anti-thrombotic therapy following acute ischaemic stroke is a challenging area in which computer-based decision support may provide assistance. Aim To evaluate influence on prescribing practice of system (CDSS) that provided patient-specific estimates expected and haemorrhagic vascular event rates under each potential therapy. Design Cluster-randomized controlled trial. Methods We recruited patients who presented for first investigation or TIA symptoms, excluding those with poor prognosis major contraindication to anticoagulation. After observation routine (6 months) hospital, centres were randomized 6 months either control (routine observed) intervention (practice observed while CDSS information). compared, between centres, risk reduction (estimated by CDSS) events achieved therapy, proportions subjects prescribed optimal identified CDSS. Results Sixteen hospitals 1952 subjects. When information, mean relative attained increased 2.7 percentage units (95%CI -0.3 5.7) odds ratio being was 1.32 (0.83 1.80). Some 55% (5/9) clinicians believed had influenced their prescribing. Conclusions trials excellent frameworks evaluating novel clinical management methods. Our feasible implement acceptable clinicians, but did not substantially drugs after stroke.