To the Editor: In their randomized controlled trial of computerized decision support in an emergency department (ED) setting, Dr. Terrell and colleagues concluded that "computerized physician order entry with decision support significantly reduced prescribing of potentially inappropriate medications for seniors," but a question regarding the study methodology exists. The trial aimed to compare the efficacy of computer-assisted decision support (experimental maneuver) with that of usual care (control maneuver) on the proportion of ED visits that resulted in prescriptions for nine targeted medications (outcome). The critical concern is whether sufficiently equal performance of the experimental and control maneuvers was achieved in the two groups so that the differences in outcome may be attributed to the effect of the experimental maneuver. Human (physician) factors cannot be overlooked as a co-intervention of computerized decision support.
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