Paul M McKie1, Daryl J Kor2, David A Cook3, Maya E Kessler4, Rickey E Carter5, Patrick M Wilson6, Laurie J Pencille7, Branden C Hickey8, Rajeev Chaudhry9. 1. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. Electronic address: mckie.paul@mayo.edu. 2. Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Department of Anesthesiology, Mayo Clinic, Rochester, Minn. 3. Office of Information and Knowledge Management, Mayo Clinic, Rochester, Minn; Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn. 4. Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn. 5. Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn. 6. Department of Health Sciences Research, Mayo Clinic, Rochester, Minn. 7. Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Office of Information and Knowledge Management, Mayo Clinic, Rochester, Minn. 8. Office of Information and Knowledge Management, Mayo Clinic, Rochester, Minn. 9. Office of Information and Knowledge Management, Mayo Clinic, Rochester, Minn; Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn.
Abstract
PURPOSE: The purpose of this research was to evaluate the impact of an outpatient computerized advisory clinical decision support system (CDSS) on adherence to guideline-recommended treatment for heart failure, atrial fibrillation, and hyperlipidemia. METHODS:Twenty care teams (109 clinicians) in a primary care practice were cluster-randomized to eitheraccess or no access to an advisory CDSS integrated into the electronic medical record. For patients with an outpatient visit, the CDSS determined if they had heart failure with reduced ejection fraction, hyperlipidemia, or atrial fibrillation; and if so, was the patient receiving guideline-recommended treatment. In the intervention group, an alert was visible in the medical record if there was a discrepancy between current and guideline-recommended treatment. Clicking the alert displayed the treatment discrepancy and recommended treatment. Outcomes included prescribing patterns, self-reported use of decision aids, and self-reported efficiency. The trial was conducted between May 1 and November 15, 2016, and incorporated 16,310 patient visits. RESULTS: The advisory CDSS increased adherence to guideline-recommended treatment for heart failure (odds ratio [OR] 7.6, 95% confidence interval [CI], 1.2, 47.5) but had no impact in atrial fibrillation (OR 0.94, 95% CI 0.15, 5.94) or hyperlipidemia (OR 1.1, 95% CI 0.6, 1.8). Clinicians with access to the CDSS self-reported greater use of risk assessment tools for heart failure (3.6 [1.1] vs 2.7 [1.0], mean [standard deviation] on a 5-point scale) but not for atrial fibrillation or hyperlipidemia. The CDSS did not impact self-assessed efficiency. The overall usage of the CDSS was low (19%). CONCLUSIONS: A computerized advisory CDSS improved adherence to guideline-recommended treatment for heart failure but not for atrial fibrillation or hyperlipidemia.
RCT Entities:
PURPOSE: The purpose of this research was to evaluate the impact of an outpatient computerized advisory clinical decision support system (CDSS) on adherence to guideline-recommended treatment for heart failure, atrial fibrillation, and hyperlipidemia. METHODS: Twenty care teams (109 clinicians) in a primary care practice were cluster-randomized to either access or no access to an advisory CDSS integrated into the electronic medical record. For patients with an outpatient visit, the CDSS determined if they had heart failure with reduced ejection fraction, hyperlipidemia, or atrial fibrillation; and if so, was the patient receiving guideline-recommended treatment. In the intervention group, an alert was visible in the medical record if there was a discrepancy between current and guideline-recommended treatment. Clicking the alert displayed the treatment discrepancy and recommended treatment. Outcomes included prescribing patterns, self-reported use of decision aids, and self-reported efficiency. The trial was conducted between May 1 and November 15, 2016, and incorporated 16,310 patient visits. RESULTS: The advisory CDSS increased adherence to guideline-recommended treatment for heart failure (odds ratio [OR] 7.6, 95% confidence interval [CI], 1.2, 47.5) but had no impact in atrial fibrillation (OR 0.94, 95% CI 0.15, 5.94) or hyperlipidemia (OR 1.1, 95% CI 0.6, 1.8). Clinicians with access to the CDSS self-reported greater use of risk assessment tools for heart failure (3.6 [1.1] vs 2.7 [1.0], mean [standard deviation] on a 5-point scale) but not for atrial fibrillation or hyperlipidemia. The CDSS did not impact self-assessed efficiency. The overall usage of the CDSS was low (19%). CONCLUSIONS: A computerized advisory CDSS improved adherence to guideline-recommended treatment for heart failure but not for atrial fibrillation or hyperlipidemia.
Authors: Willy Weng; Chris Blanchard; Jennifer L Reed; Kara Matheson; Ciorsti McIntyre; Chris Gray; John L Sapp; Martin Gardner; Amir AbdelWahab; Jason Yung; Ratika Parkash Journal: Cardiovasc Digit Health J Date: 2020-11-28
Authors: Matthew W Segar; Kershaw V Patel; Anne S Hellkamp; Muthiah Vaduganathan; Yuliya Lokhnygina; Jennifer B Green; Siu-Hin Wan; Ahmed A Kolkailah; Rury R Holman; Eric D Peterson; Vaishnavi Kannan; Duwayne L Willett; Darren K McGuire; Ambarish Pandey Journal: J Am Heart Assoc Date: 2022-06-03 Impact factor: 6.106