Journal of medical Internet research
Improving Musculoskeletal Care Quality With a Web-Based Clinical Decision Support System in UK Primary Care: Mixed Methods Cluster-Randomized Controlled Trial
By Hill J, Birkinshaw H, Usman M and 13 others.
Abstract
Background
Musculoskeletal (MSK) conditions account for one in seven general practice consultations in the United Kingdom. Despite national guidelines, suboptimal care remains common. Digital clinical decision support systems (CDSSs) offer a promising route to improve care quality but have not been robustly evaluated in MSK primary care.
Objective
This study aimed to evaluate the efficacy, clinical effectiveness and cost-effectiveness, carbon reduction, safety, and implementation of a CDSS (CrossCover) for MSK consultations in UK general practice.
Methods
We conducted a mixed methods, cluster-randomized controlled trial in 19 general practices between February and July 2024. Practices were randomized 1:1, stratified by list size. Intervention practices received training and access to the web-based CDSS for 3 months. We analyzed anonymized electronic health records to identify all adult MSK consultations. The primary outcome was the proportion of patient records containing one or more of 12 predefined non-evidence-based management options, assessed by blinded clinical review of 120 patient records (60 per arm). Reviewers assessed the complete 3-month record in both arms; in the intervention arm, suboptimal management was counted only where it occurred at a consultation in which the CDSS was used. Secondary outcomes included intention-to-treat treatment comparisons of self-management advice, prescriptions, referrals, and imaging. Clinician engagement, safety, environmental and economic modeling, and clinician experiences from semistructured interviews were evaluated. Outcome assessors were blinded; clinicians were not.