Adoption of shared decision-making and clinical decision support for reducing cardiovascular disease risk in community health centers.
Adoption of shared decision-making and clinical decision support for reducing cardiovascular disease risk in community health centers.
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采用共同的决策和临床决策支持，以降低社区卫生中心的心血管疾病风险。
作者：
基于电子健康记录（EHR）的共享决策（SDM）和临床决策支持（CDS）系统可以提高心血管疾病（CVD）护理质量和风险因素管理。在一项有效性试验中，CV Wizard系统的使用显示出对高危社区卫生中心（CHC）患者的CVD风险的有益影响，但系统采用率总体较低。我们评估了哪些多水平特征与系统使用相关。分析包括2018年9月至2020年3月在42家诊所进行的80，195次就诊，其中17，931例患者具有高CVD风险和/或不受控制的风险因素。数据来自CV Wizard存储库和EHR数据，以及对44家诊所提供者的调查。调整后的混合效应多变量Poisson回归分析评估了与系统使用相关的因素。我们包括诊所和提供者级别的聚类作为随机效应，以解释嵌套数据。系统使用的可能性在与CVD风险较高的患者和较长时间的接触中显着较高，当提供者落后于计划>10分钟时，以及其他因素时，系统使用的可能性较低。调查参与者普遍对该系统表示高度满意，但在时间有限或室友工作人员没有为提供者打印系统输出时，不太可能使用该系统。CHC提供者优先使用这个系统的患者最大的心血管疾病的风险，当时间允许，当房间的工作人员使信息随时可用。社区卫生中心的财政限制对消除改善系统使用的障碍造成了巨大挑战，并对卫生公平产生了影响。需要研究如何改进社区卫生中心采用SDM和CDS的情况。 ClinicalTrials.gov，NCT 03001713，https://clinicaltrials.gov/
Electronic health record (EHR)-based shared decision-making (SDM) and clinical decision support (CDS) systems can improve cardiovascular disease (CVD) care quality and risk factor management. Use of the CV Wizard system showed a beneficial effect on high-risk community health center (CHC) patients’ CVD risk within an effectiveness trial, but system adoption was low overall. We assessed which multi-level characteristics were associated with system use. Analyses included 80 195 encounters with 17 931 patients with high CVD risk and/or uncontrolled risk factors at 42 clinics in September 2018–March 2020. Data came from the CV Wizard repository and EHR data, and a survey of 44 clinic providers. Adjusted, mixed-effects multivariate Poisson regression analyses assessed factors associated with system use. We included clinic- and provider-level clustering as random effects to account for nested data. Likelihood of system use was significantly higher in encounters with patients with higher CVD risk and at longer encounters, and lower when providers were >10 minutes behind schedule, among other factors. Survey participants reported generally high satisfaction with the system but were less likely to use it when there were time constraints or when rooming staff did not print the system output for the provider. CHC providers prioritize using this system for patients with the greatest CVD risk, when time permits, and when rooming staff make the information readily available. CHCs’ financial constraints create substantial challenges to addressing barriers to improved system use, with health equity implications. Research is needed on improving SDM and CDS adoption in CHCs. ClinicalTrials.gov, NCT03001713, https://clinicaltrials.gov/
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影响因子：
24
作者：
Casey DE Jr;Thomas RJ;Bhalla V;Commodore-Mensah Y;Heidenreich PA;Kolte D;Muntner P;Smith SC Jr;Spertus JA;Windle JR;Wozniak GD;Ziaeian B
通讯作者：
Ziaeian B
影响因子：
5.7
作者：
Jean-Jacques, Muriel;Persell, Stephen D.;Baker, David W.
通讯作者：
Baker, David W.
影响因子：
16.2
作者：
通讯作者：
--
DOI：
10.1136/amiajnl-2010-000013
发表时间：
2011-11-01
影响因子：
6.4
作者：
Ash, Joan S.;Sittig, Dean F.;Middleton, Blackford
通讯作者：
Middleton, Blackford
DOI：
10.1186/s13012-017-0644-2
发表时间：
2017-09-15
期刊：
Implementation science : IS
影响因子：
--
作者：
Liberati EG;Ruggiero F;Galuppo L;Gorli M;González-Lorenzo M;Maraldi M;Ruggieri P;Polo Friz H;Scaratti G;Kwag KH;Vespignani R;Moja L
通讯作者：
Moja L