Clinical decision support directed to primary care patients and providers reduces cardiovascular risk: a randomized trial
Clinical decision support directed to primary care patients and providers reduces cardiovascular risk: a randomized trial
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DOI：
10.1093/jamia/ocy085
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发表时间：
2018-09-01
影响因子：
6.4
通讯作者：
O'Connor, Patrick J.
中科院分区：
文献类型：
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作者：
Sperl-Hillen, JoAnn M.;Crain, A. Lauren;O'Connor, Patrick J.
目的：验证在初级保健环境中使用临床决策支持（CDS）系统可以降低患者心血管（CV）风险的假设。材料和方法：20个初级保健诊所随机分配到常规护理（UC）或CDS。对于通过算法确定具有高CV风险的CDS门诊患者，电子健康记录（EHR）提示客房工作人员打印CDS，其中确定了针对血脂、血压、体重、烟草或阿司匹林管理的循证治疗方案，并根据对患者的潜在益处对其进行优先排序。意向治疗分析包括7914名在指数门诊就诊时符合高CV风险标准且至少有一次指数后就诊的成年人，考虑聚类，并评估对14个月期间10年CV风险预测年变化率的影响。结果：在75%的目标访问中打印了CDS，提供者报告了85%到98%的干预措施的各个方面的满意度。预测的10年CV绝对风险年变化率，CDS组明显好于UC组（-0.59% vs. +1.66%, -2.24%; P < 0.001），指数后12个月的10年CV风险差异有利于CDS组（UC 24.4%, CDS 22.5%, P < 0.03）。讨论：在初级保健访问工作流程中部署到患者和提供者，并将病房工作人员的CDS显示和打印负担限制在两次鼠标点击，有助于提高CDS使用率和提供者满意度。结论：这种基于网络的ehr整合门诊CDS系统显著改善了目标成人10年心血管风险轨迹。
Objective: To test the hypothesis that use of a clinical decision support (CDS) system in a primary care setting can reduce cardiovascular (CV) risk in patients.Materials and Methods: Twenty primary care clinics were randomly assigned to usual care (UC) or CDS. For CDS clinic patients identified algorithmically with high CV risk, rooming staff were prompted by the electronic health record (EHR) to print CDS that identified evidence-based treatment options for lipid, blood pressure, weight, tobacco, or aspirin management and prioritized them based on potential benefit to the patient. The intention-to-treat analysis included 7914 adults who met high CV risk criteria at an index clinic visit and had at least one post-index visit, accounted for clustering, and assessed impact on predicted annual rate of change in 10-year CV risk over a 14-month period.Results: The CDS was printed at 75% of targeted visits, and providers reported 85% to 98% satisfaction with various aspects of the intervention. Predicted annual rate of change in absolute 10-year CV risk was significantly better in CDS clinics than in UC clinics (-0.59% vs. +1.66%, -2.24%; P < .001), with difference in 10-year CV risk at 12 months post-index favoring the CDS group (UC 24.4%, CDS 22.5%, P < .03).Discussion: Deploying to both patients and providers within primary care visit workflow and limiting CDS display and print burden to two mouse clicks by rooming staff contributed to high CDS use rates and high provider satisfaction. Conclusion: This EHR-integrated, web-based outpatient CDS system significantly improved 10-year CV risk trajectory in targeted adults.