Correspondence  |   September 2018
In Reply
Author Notes
  • University of Michigan Medical School, Ann Arbor, Michigan (S.K.).
  • (Accepted for publication June 8, 2018.)
    (Accepted for publication June 8, 2018.)×
Article Information
Correspondence   |   September 2018
In Reply
Anesthesiology 9 2018, Vol.129, 615-616. doi:10.1097/ALN.0000000000002351
Anesthesiology 9 2018, Vol.129, 615-616. doi:10.1097/ALN.0000000000002351
We thank our colleagues for their interest in the published work1  and their thoughtful comments. The study of clinical decision support, process of care measures, and clinical outcomes is a complex area that demands increased attention from the peer-reviewed literature, academic institutions, and industry.
We concur with Dr. Freundlich et al. that multicenter studies of clinical decision support are necessary to advance the field. To maximize generalizability and reproducibility, multicenter research is a natural step in the evolution of evidence-based practice change. Donabedian’s classic “ structure-process-outcomes” framework clearly identifies that the context within which care is delivered must be incorporated into clinical and health services research.2  A decision support system that is associated with clinical impact in one health system or structure of care may demonstrate no value in another setting, or vice versa. Multicenter pragmatic clinical trials and Randomized, Embedded, Multifactorial, Adaptive Platform (also known as “REMAP”) trial designs are potential cost-effective avenues to study clinical decision support.3  With support from a multitude of national and international anesthesiology organizations, the Multicenter Perioperative Outcomes Group, on behalf of its more than 40 contributing member organizations, has invested in the Initiative for Multicenter Perioperative Clinical Trials (IMPACT).4  We look forward to working with centers and investigators from around the world that wish to use this infrastructure for pragmatic perioperative trials.