An Informatics Approach to Implement Support for Shared Decision Making for Primary Prevention Statin Therapy.
An Informatics Approach to Implement Support for Shared Decision Making for Primary Prevention Statin Therapy.
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DOI：
10.1177/2381468318777752
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发表时间：
2018-01
影响因子：
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通讯作者：
Kronish I
中科院分区：
文献类型：
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作者：
Ye S;Leppin AL;Chan AY;Chang N;Moise N;Poghosyan L;Montori VM;Kronish I
背景资料。共享决策(SDM)被推荐在他汀类药物治疗开始用于一级预防之前，但未得到充分利用。我们设计了一个信息学决策支持工具，以促进在护理点使用梅奥诊所他汀类药物选择决策辅助工具，并评估其影响。方法：研究方法。使用迭代方法，我们设计并实施了嵌入电子健康记录(EHR)中的一键式决策支持工具，以自动计算10年动脉粥样硬化性心血管疾病(ASCVD)风险并填充他汀类药物选择决策辅助工具。我们调查了两家诊所的初级保健提供者，了解他们在实施干预前后对SDM的态度，以及他们对SDM用于初级预防他汀类药物治疗的使用情况和感知能力。他汀类药物选择网站的三个月网络流量在干预措施部署前后进行了计算。结果。60名初级保健提供者(24名[40%]主治医生和36名[60%]家政医生)完成了岗前调查。在部署电子病历工具后，受访者更了解他汀类药物选择决策辅助工具(P<；0.001)，报告更能胜任自我发展管理(P=0.047)，并报告在考虑启动他汀类药物时更经常使用决策辅助工具(P=0.043)。患者提供者定向量表(前4.23±0.40对后4.16±0.38，P=0.11)和信念量表(前21.4±2.1对后21.1±2.0，P=0.35)对SDM的态度无显著变化。他汀类药物选择决策辅助工具的网络使用率从每千次门诊就诊3.4%增加到5.2%(P=0.002)。结论。实施护理点决策支持工具增加了对初级预防他汀类药物治疗决策辅助工具的使用。这一效应似乎并不是由医生对SDM态度的任何伴随变化所调节的。
Background. Shared decision making (SDM) is recommended prior to initiation of statin therapy for primary prevention but is underutilized. We designed an informatics decision-support tool to facilitate use of the Mayo Clinic Statin Choice decision aid at the point-of-care and evaluated its impact. Methods. Using an iterative approach, we designed and implemented a single-click decision-support tool embedded within the electronic health records (EHRs) to automate the calculation of 10-year atherosclerotic cardiovascular disease (ASCVD) risk and populate the Statin Choice decision aid. We surveyed primary care providers at two clinics regarding their attitudes about SDM before and after deployment of intervention, as well as their usage of and perceived competence regarding SDM for primary prevention statin therapy. Three-month web traffic to the Statin Choice website was calculated before and after deployment of the intervention. Results. Pre–post surveys were completed by 60 primary care providers (24 [40%] attending physicians and 36 [60%] housestaff physicians). After deployment of the EHR tool, respondents were more aware of the Statin Choice decision aid (P < 0.001), reported being more competent regarding SDM (P = 0.047), and reported using decision aids more often when considering statin initiation (P = 0.043). There was no significant change in attitudes about SDM as measured through the Patient Provider Orientation Scale (pre 4.23 ± 0.40 v. post 4.16 ± 0.38, P = 0.11) and the SDM belief scale (pre 21.4 ± 2.1 v. post 21.1 ± 2.0, P = 0.35). Web-based usage rates for the Statin Choice decision aid increased from 3.4 to 5.2 per 1,000 outpatient clinic visits (P = 0.002). Conclusions. Implementation of a point-of-care decision-support tool increased the usage of decision aids for primary prevention statin therapy. This effect does not appear to be mediated by any concomitant changes in physician attitude toward SDM.