Development of the ADFICE_IT clinical decision support system to assist deprescribing of fall-risk increasing drugs: A user-centered design approach

Introduction Deprescribing fall-risk increasing drugs (FRIDs) is a promising intervention for reducing the risk of falling in older adults. Applying appropriate deprescribing in practice can be difficult due to the outcome uncertainties associated with stopping the use of FRIDs. The AD F ICE_IT study addresses this complexity with a clinical decision support system (CDSS) that facilitates optimum deprescribing of FRIDs through use of a fall-risk prediction model, aggregation of deprescribing guidelines, and joint medication management. The development process of the CDSS is described in this paper. Methods Development followed a user-centered design approach in which users and experts were involved throughout each phase. In phase I, a prototype of the CDSS was developed which involved a scoping and systematic literature review, European survey ( n = 581), and semi-structured interviews with physicians ( n = 19), as well as the aggregation and testing of deprescribing guidelines and the development of the fall-risk prediction model. In phase II, the feasibility of the CDSS was tested by means of two usability testing rounds with end users ( n = 11). Results The final CDSS consists of five web pages. A connection between the Electronic Health Record allows for the retrieval of patient data into the CDSS. Key design requirements for the CDSS include easy-to-use features for fast-paced clinical practice environments, actionable deprescribing recommendations, information transparency, and visualization of the patient’s fall-risk estimation. Key elements for the software include a modular architecture, open source, and good security. Conclusion The AD F ICE_IT CDSS supports physicians in deprescribing FRIDs optimally to prevent falls in older patients. Due to continuous user and expert involvement, each new feedback round led to an improved version of the system. Currently, a multicenter, cluster-randomized controlled trial with process evaluation at hospitals in the Netherlands is being conducted to test the effect of the CDSS on falls. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The ADFICE_IT project is supported by funding from the Netherlands Organization for Health Research and Development (ZonMw, Grant 848017004), The Hague and the Amsterdams Universiteitsfonds: Gepersonaliseerde Medicatieaanpassing bij Oudere Vallers. KMS was supported by US NIH grant T32-GM007592. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Medical Ethics Research Committee of the Amsterdam University Medical Center (Amsterdam UMC, location University of Amsterdam; W19_310 # 19.368) declared that the Medical Research Involving Human Subjects Act did not apply to this study. All study participants gave written informed consent prior to data collection. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data from all studies is available upon request. Data from the trial will be made available for other researchers after the study is completed for replication purposes and for original research questions, and is being stored in accordance with General Data Protection Regulation. For this, a request by researchers will need to be submitted for approval from the ADFICE\_IT Steering Group. More information about the ADFICE\_IT project can be found at . Contact for general queries Contact: Sara S Groos Email address: s.s.groos{at}amsterdamumc.nl Address: Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands Contact for scientific queries Contact: Prof Dr. Nathalie van der Velde Address: Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands