Impact of four training conditions on physician use of a web-based clinical decision support system

Background: Training has been identified as an important barrier to implementation of clinical decision support systems (CDSSs), but little is known about the effectiveness of different training approaches. Methods: Using an observational retrospective cohort design, we examined the impact of four training conditions on physician use of a CDSS: (1) computer lab training with individualized follow-up (CL-FU) (n = 40), (2) computer lab training without follow-up (CL) (n = 177), (3) lecture demonstration (LD) (n = 16), or (4) no training (NT) (n =134). Odds ratios of any use and ongoing use under training conditions were compared to no training over a 2-year follow-up period. Results: CL-FU was associated with the highest percent of active users and odds for any use (90.0%, odds ratio (OR) = 10.2, 95% confidence interval (CI): 3.2-32.9) and ongoing use (60.0%, OR = 6.1 95% CI: 2.6-13.7), followed by CL (any use = 81.4%, OR= 5.3, CI: 2.9-9.6; ongoing use = 28.8%, OR = 1.7, 95% CI: 1.0-3.0). LD was not superior to no training (any use = 47%, ongoing use = 22.4%). Conclusion: Training format may have differential effects on initial and long-term follow-up of CDSSs use by physicians. (C) 2013 Elsevier B.V. All rights reserved.