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Appl Clin Inform 2026; 17(02): 145-152
DOI: 10.1055/a-2830-2528
Research Article

Implementing Clinical Decision Support for Primary Care Preventive Screenings for People with Physical Disabilities

Authors

  • Tyler G. James 

    1   Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States

  • Suhas Kellampalli

    1   Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States

  • Beatrice Palazzolo

    1   Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States

  • Lorrie Carbone

    1   Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States

  • Robert Heizelman

    1   Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States

  • Elham Mahmoudi

    1   Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States

  • Michael M. McKee

    1   Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, United States

Funding Information This study is supported by funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), under the Administration for Community Living of the U.S. Department of Health and Human Services (grant no.: 90RTHF0001-01-00). In addition, we use resources supported by the University of Michigan's Michigan Institute for Clinical and Health Research (MICHR), which is funded by the National Institutes of Health/National Center for Advancing Translational Sciences (grant no.: UL1TR002240).
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Abstract

Background

People with physical disabilities are one of the largest subgroups of people with disabilities, and this group experiences significant health disparities. Given the risk of preventable multimorbidity among this group, there is an opportunity to improve primary care for this population.

Objective

The goal of this study was to use a clinical decision support (CDS) tool to improve preventive screenings in primary care for people with physical disabilities.

Methods

We used a convergent mixed methods study design—integrating quantitative and qualitative data—within a pilot implementation study. Our CDS intervention was implemented at a single, family medicine clinic in an academic medical center in southeast Michigan. Quantitative data were focused on providers using the CDS tool within the electronic health record, while qualitative data were gathered from group meetings and semi-structured interviews with primary care providers at the intervention clinic.

Results

The CDS tool was triggered for 1,668 unique encounters and was used only 10% of the time. Among use cases, a recommended preventive screening order was placed 40% of the time. Three themes were developed, focused on (1) inadequate incentive and cognitive task management systems, (2) competing priorities and patient burden, and (3) liking the CDS alert.

Conclusion

Although receptive, primary care providers in our study infrequently used the CDS alert. Through merging these mixed methods data, we identified several opportunities to improve the CDS tool including reducing cognitive burden, providing details on the justification for the recommended orders, and better workflow integration.

Keywords

physical disability - preventive screenings - clinical decision support - primary care

Protection of Human and Animal Subjects

This study was approved by the University of Michigan's Institutional Review Board.


Contributors' Statement

T.G.J.: conceptualization, data curation, formal analysis, investigation, methodology, validation, writing—original draft, writing—review and editing; S.K.: formal analysis, writing—original draft, writing—review and editing; B.P.: data curation, formal analysis, methodology, software, writing—review and editing; L.C.: project administration, writing—review and editing; R.J.H.: conceptualization, writing—review and editing; E.M.: conceptualization, funding acquisition, supervision, writing—review and editing; M.M.M.: conceptualization, funding acquisition, investigation, supervision, writing—review and editing.


Supplementary Material



Publication History

Received: 30 June 2025

Accepted after revision: 06 March 2026

Accepted Manuscript online:
09 March 2026

Article published online:
20 March 2026

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