{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T08:25:51Z","timestamp":1774340751225,"version":"3.50.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,10,20]],"date-time":"2022-10-20T00:00:00Z","timestamp":1666224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Science","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100007185","name":"UCLA","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007185","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018188","name":"Clinical and Translational Science Institute","doi-asserted-by":"publisher","award":["TL1TR001883"],"award-info":[{"award-number":["TL1TR001883"]}],"id":[{"id":"10.13039\/100018188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,13]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Clinical decision support (CDS) alerts may improve health care quality but \u201calert fatigue\u201d can reduce provider responsiveness. We analyzed how the introduction of competing alerts affected provider adherence to a single depression screening alert.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We analyzed the audit data from all occurrences of a CDS alert at a large academic health system. For patients who screen positive for depression during ambulatory visits, a noninterruptive alert was presented, offering a number of relevant documentation actions. Alert adherence was defined as the selection of any option offered within the alert. We assessed the effect of competing clinical guidance alerts presented during the same encounter and the total of all CDS alerts that the same provider had seen in the prior 90 days, on the probability of depression screen alert adherence, adjusting for physician and patient characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The depression alert fired during 55\u00a0649 office visits involving 418 physicians and 40\u00a0474 patients over 41 months. After adjustment, physicians who had seen the most alerts in the prior 90 days were much less likely to respond (adjusted OR highest\u2013lowest quartile, 0.38; 95% CI 0.35\u20130.42; P\u2009&amp;lt;\u2009.001). Competing alerts in the same visit further reduced the likelihood of adherence only among physicians in the middle two quartiles of alert exposure in the prior 90 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adherence to a noninterruptive depression alert was strongly associated with the provider\u2019s cumulative alert exposure over the past quarter. Health systems should monitor providers\u2019 recent alert exposure as a measure of alert fatigue.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jamia\/ocac191","type":"journal-article","created":{"date-parts":[[2022,10,20]],"date-time":"2022-10-20T18:17:23Z","timestamp":1666289843000},"page":"64-72","source":"Crossref","is-referenced-by-count":21,"title":["Distinct components of alert fatigue in physicians\u2019 responses to a noninterruptive clinical decision support alert"],"prefix":"10.1093","volume":"30","author":[{"given":"Douglas A","family":"Murad","sequence":"first","affiliation":[{"name":"Medical Informatics, Kaiser Permanente Southern California , San Diego, CA, USA"}]},{"given":"Yusuke","family":"Tsugawa","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine at UCLA , Los Angeles, CA, USA"}]},{"given":"David A","family":"Elashoff","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine at UCLA , Los Angeles, CA, USA"}]},{"given":"Kevin M","family":"Baldwin","sequence":"additional","affiliation":[{"name":"UCLA Health Information Technology , Los Angeles, CA, USA"}]},{"given":"Douglas S","family":"Bell","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine at UCLA , Los Angeles, CA, USA"},{"name":"UCLA Health Information Technology , Los Angeles, CA, USA"}]}],"member":"286","published-online":{"date-parts":[[2022,10,20]]},"reference":[{"issue":"26","key":"2022121408271645200_ocac191-B1","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1056\/NEJMsa022615","article-title":"The quality of health care delivered to adults in the United States","volume":"348","author":"McGlynn","year":"2003","journal-title":"N Engl J 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