{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T12:18:44Z","timestamp":1761394724485},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"e1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Objective Variation in the use of tests and treatments has been demonstrated to be substantial between providers and geographic regions. This study assessed variation between outpatient providers in overriding electronic prescribing warnings.<\/jats:p><jats:p>Methods Responses to warnings were prospectively logged. Random effects models were used to calculate provider-to-provider variation in the rates for the decisions to override warnings in 6 different clinical domains: medication allergies, drug-drug interactions, duplicate drugs, renal recommendations, age-based recommendations, and formulary substitutions.<\/jats:p><jats:p>Results A total of 157\u2009482 responses were logged. Differences between 1717 providers accounted for 11% of the overall variability in override rates, so that while the average override rate was 45.2%, individual provider rates had a wide range with a 95% confidence interval (CI) (13.7%-76.7% ). The highest variations between providers were observed in the categories age-based (25.4% of total variability; average override rate 70.2% [95% CI, 29.1%-100% ]) and renal recommendations (24.2%; average 70% [95% CI, 29.5%-100% ]), and provider responses within these 2 categories were most often clinically inappropriate according to prior work. Among providers who received at least 10 age-based recommendations, 64 of 238 (27%) overrode \u2265\u200990% of the warnings and 13 of 238 (5%) overrode all of them. Of those who received at least 10 renal recommendations, 36 of 92 (39%) overrode \u2265\u200990% of the alerts and 9 of 92 (10%) overrode all of them.<\/jats:p><jats:p>Conclusions The decision to override prescribing warnings shows variation between providers, and the magnitude of variation differs among the clinical domains of the warnings; more variation was observed in areas with more inappropriate overrides.<\/jats:p>","DOI":"10.1093\/jamia\/ocv117","type":"journal-article","created":{"date-parts":[[2015,10,25]],"date-time":"2015-10-25T07:01:08Z","timestamp":1445756468000},"page":"e93-e98","source":"Crossref","is-referenced-by-count":14,"title":["Provider variation in responses to warnings: do the same providers run stop signs repeatedly?"],"prefix":"10.1093","volume":"23","author":[{"given":"Patrick E","family":"Beeler","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine & Primary Care, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Research Center for Medical Informatics, University Hospital Zurich, Switzerland"}]},{"given":"E John","family":"Orav","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine & Primary Care, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA"}]},{"given":"Diane L","family":"Seger","sequence":"additional","affiliation":[{"name":"Partners Healthcare Systems, Inc, Wellesley, Massachusetts, USA"}]},{"given":"Patricia C","family":"Dykes","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine & Primary Care, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}]},{"given":"David W","family":"Bates","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine & Primary Care, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Partners Healthcare Systems, Inc, Wellesley, Massachusetts, USA"}]}],"member":"286","published-online":{"date-parts":[[2015,10,24]]},"reference":[{"issue":"4","key":"2020110612384759300_ocv117-B1","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1215\/03616878-12-4-741","article-title":"Small area analysis: a review and analysis of the North American literature","volume":"12","author":"Paul-Shaheen","year":"1987","journal-title":"J Health Polit Policy Law"},{"issue":"4117","key":"2020110612384759300_ocv117-B2","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1126\/science.182.4117.1102","article-title":"Small area variations in health care delivery","volume":"182","author":"Wennberg","year":"1973","journal-title":"Science"},{"issue":"1","key":"2020110612384759300_ocv117-B3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.healthpol.2013.11.010","article-title":"Forty years of unwarranted variation\u2014and still counting","volume":"114","author":"Wennberg","year":"2014","journal-title":"Health Policy Amst Neth"},{"issue":"9898","key":"2020110612384759300_ocv117-B4","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/S0140-6736(13)61215-5","article-title":"Understanding of regional variation in the use of surgery","volume":"382","author":"Birkmeyer","year":"2013","journal-title":"Lancet"},{"issue":"7","key":"2020110612384759300_ocv117-B5","first-page":"811","article-title":"Professional uncertainty and the problem of supplier-induced demand","volume":"16","author":"Wennberg","year":"1982","journal-title":"Soc Sci Med 1982"},{"issue":"4","key":"2020110612384759300_ocv117-B6","doi-asserted-by":"crossref","first-page":"327","DOI":"10.2105\/AJPH.74.4.327","article-title":"Hysterectomy: variations in rates across small areas and across physicians\u2019 practices","volume":"74","author":"Roos","year":"1984","journal-title":"Am J Public Health"},{"issue":"6","key":"2020110612384759300_ocv117-B7","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1542\/peds.59.6.821","article-title":"Changes in tonsillectomy rates associated with feedback and review","volume":"59","author":"Wennberg","year":"1977","journal-title":"Pediatrics"},{"issue":"1","key":"2020110612384759300_ocv117-B8","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1056\/NEJMsa0910881","article-title":"Regional variations in diagnostic practices","volume":"363","author":"Song","year":"2010","journal-title":"N Engl J Med"},{"issue":"6","key":"2020110612384759300_ocv117-B9","first-page":"1351","article-title":"Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors","volume":"34","author":"Fisher","year":"2000","journal-title":"Health Serv Res"},{"issue":"6","key":"2020110612384759300_ocv117-B10","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1001\/jamainternmed.2013.2509","article-title":"Variation in medication adherence in heart failure","volume":"173","author":"Zhang","year":"2013","journal-title":"JAMA Intern Med"},{"issue":"8","key":"2020110612384759300_ocv117-B11","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1001\/jama.1973.03220360029007","article-title":"Use of laboratory tests and pharmaceuticals. Variation among physicians and effect of cost audit on subsequent use","volume":"225","author":"Schroeder","year":"1973","journal-title":"JAMA"},{"issue":"21","key":"2020110612384759300_ocv117-B12","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1056\/NEJMp1010220","article-title":"Geographic variation in the quality of prescribing","volume":"363","author":"Zhang","year":"2010","journal-title":"N Engl J Med"},{"issue":"2","key":"2020110612384759300_ocv117-B13","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1197\/jamia.M1809","article-title":"Overriding of drug safety alerts in computerized physician order entry","volume":"13","author":"Van der Sijs","year":"2006","journal-title":"J Am Med Inform Assoc"},{"issue":"3","key":"2020110612384759300_ocv117-B14","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1136\/amiajnl-2013-001813","article-title":"Overrides of medication-related clinical decision support alerts in outpatients","volume":"21","author":"Nanji","year":"2014","journal-title":"J Am Med Inform Assoc"},{"issue":"22","key":"2020110612384759300_ocv117-B15","doi-asserted-by":"crossref","first-page":"2839","DOI":"10.1001\/jama.286.22.2839","article-title":"Guided medication dosing for inpatients with renal insufficiency","volume":"286","author":"Chertow","year":"2001","journal-title":"JAMA"},{"issue":"7","key":"2020110612384759300_ocv117-B16","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1001\/archinte.165.7.802","article-title":"Guided prescription of psychotropic medications for geriatric inpatients","volume":"165","author":"Peterson","year":"2005","journal-title":"Arch Intern Med"},{"issue":"1","key":"2020110612384759300_ocv117-B17","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.healthpol.2013.08.002","article-title":"A systematic review of medical practice variation in OECD countries","volume":"114","author":"Corallo","year":"2014","journal-title":"Health Policy Amst Neth"},{"issue":"1","key":"2020110612384759300_ocv117-B18","doi-asserted-by":"crossref","first-page":"20","DOI":"10.7326\/M13-2231","article-title":"Interinstitutional variation in management decisions for treatment of 4 common types of cancer: a multi-institutional cohort study","volume":"161","author":"Weeks","year":"2014","journal-title":"Ann Intern Med"},{"issue":"3","key":"2020110612384759300_ocv117-B19","doi-asserted-by":"crossref","first-page":"196","DOI":"10.7326\/0003-4819-141-3-200408030-00008","article-title":"The impact of peer management on test-ordering behavior","volume":"141","author":"Neilson","year":"2004","journal-title":"Ann Intern Med"},{"issue":"6","key":"2020110612384759300_ocv117-B20","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1197\/jamia.M1370","article-title":"Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality","volume":"10","author":"Bates","year":"2003","journal-title":"J Am Med Inform Assoc"},{"issue":"7","key":"2020110612384759300_ocv117-B21","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1377\/hlthaff.2014.0041","article-title":"Big data in health care: using analytics to identify and manage high-risk and high-cost patients","volume":"33","author":"Bates","year":"2014","journal-title":"Health Aff Proj Hope"},{"issue":"13","key":"2020110612384759300_ocv117-B22","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1001\/jama.289.13.1652","article-title":"Drug-drug interactions among elderly patients hospitalized for drug toxicity","volume":"289","author":"Juurlink","year":"2003","journal-title":"JAMA"},{"issue":"15","key":"2020110612384759300_ocv117-B23","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1001\/archinte.1997.00440360105012","article-title":"Antibiotic optimization. An evaluation of patient safety and economic outcomes","volume":"157","author":"Fraser","year":"1997","journal-title":"Arch Intern Med"},{"issue":"5","key":"2020110612384759300_ocv117-B24","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1093\/jac\/dkp062","article-title":"Impact of a computer-generated alert system prompting review of antibiotic use in hospitals","volume":"63","author":"Lesprit","year":"2009","journal-title":"J Antimicrob Chemother"},{"issue":"6","key":"2020110612384759300_ocv117-B25","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s40264-013-0022-1","article-title":"Use of an on-demand drug-drug interaction checker by prescribers and consultants: a retrospective analysis in a Swiss teaching hospital","volume":"36","author":"Beeler","year":"2013","journal-title":"Drug Saf Int J Med Toxicol Drug Exp"},{"issue":"4","key":"2020110612384759300_ocv117-B26","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1136\/amiajnl-2010-000039","article-title":"Factors influencing alert acceptance: a novel approach for predicting the success of clinical decision support","volume":"18","author":"Seidling","year":"2011","journal-title":"J Am Med Inform Assoc"},{"issue":"3","key":"2020110612384759300_ocv117-B27","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1136\/amiajnl-2013-001813","article-title":"The effect of provider characteristics on the responses to medication-related decision support alerts","volume":"21","author":"Cho","year":"2014","journal-title":"J Am Med Inform Assoc"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/23\/e1\/e93\/34148278\/ocv117.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/23\/e1\/e93\/34148278\/ocv117.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T04:13:25Z","timestamp":1653365605000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/23\/e1\/e93\/2379799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,24]]},"references-count":27,"journal-issue":{"issue":"e1","published-online":{"date-parts":[[2015,10,24]]},"published-print":{"date-parts":[[2016,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocv117","relation":{},"ISSN":["1527-974X","1067-5027"],"issn-type":[{"value":"1527-974X","type":"electronic"},{"value":"1067-5027","type":"print"}],"subject":[],"published-other":{"date-parts":[[2016,4]]},"published":{"date-parts":[[2015,10,24]]}}}