CV Wizard: Does a Prioritized, Point-of-Care Clinical Decision Support Tool Improve Guideline-Based CVD Risk Factor Control in Safety Net Clinics?

CV 向导：优先的护理点临床决策支持工具能否改善安全网诊所中基于指南的 CVD 风险因素控制？

• 批准号: 10216556
• 负责人: RACHEL GOLD
• 金额: $ 31.22万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-09 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10216556
• 关键词: Address; Adoption; Affect; American; Appointment; Aspirin; Blood Pressure; Body mass index; COVID-19; COVID-19 pandemic; Cardiovascular Diseases; Cardiovascular system; Caring; Centers for Population Health; Clinic; Clinic Visits; Clinical; Clinical Decision Support Systems; Community Developments; Data; Decision Making; Disease Outcome; Documentation; Electronic Health Record; Evaluation; Event; Face; Funding Mechanisms; Future; General Population; Glycosylated hemoglobin A; Goals; Guidelines; Health; Health Policy; Healthcare Systems; Infection; Informatics; Intervention; Interview; Investments; Knowledge; Learning; Lipids; Low income; Measures; Methods; Morbidity - disease rate; Neighborhood Health Center; Outcome; Parents; Patients; Period Analysis; Persons; Population; Preventive care; Primary Health Care; Process; Provider; Qualitative Methods; Quality of Care; Randomized; Recommendation; Regression Analysis; Relapse; Research; Resources; Risk Factors; Risk Management; Role; Smoking; Targeted Research; Technology; Telephone; Testing; Time; TimeLine; Training; Translating; Update; Visit; Wait Time; Work; arm; base; blood pressure regulation; cardioprotection; cardiovascular disorder risk; care outcomes; care providers; clinical decision support; clinical encounter; coronavirus disease; cost; design; digital; disparity reduction; evidence based guidelines; experience; follow-up; health care settings; health disparity; health practice; high risk; high risk population; improved; indexing; innovation; mortality; pandemic disease; parent grant; patient engagement; patient oriented; personalized care; point of care; primary care setting; primary outcome; response; safety net; shared decision making; socioeconomics; success; support tools; tool; uptake; virtual

PROJECT SUMMARY / ABSTRACT: Substantial progress in reducing cardiovascular disease (CVD) morbidity and mortality would be achieved if evidence-based guidelines for CVD risk factor control were implemented consistently in primary care settings. Electronic health record (EHR)-based clinical decision support (CDS) systems that identify uncontrolled CVD risk factors and provide individualized care recommendations improved rates of guideline-concordant CVD care in large, integrated healthcare settings, but little is known about how effective such CDS may be in safety net community health centers (CHCs). CHCs' socioeconomically vulnerable patients have far worse CVD risk factor control and higher rates of major CVD events than the general population. Implementing CDS that leads to improved CVD risk factor control in CHCs could reduce national disparities in CVD outcomes, but CHCs rarely have the resources to develop sophisticated CDS, and very few currently have such systems for CVD care. The proposed study is designed to address this. We will randomize 60 CHCs with a shared EHR to immediate vs. delayed implementation of a sophisticated CDS system that provides point-of-care CVD care recommendations to the primary care provider and the patient, and has been proven highly successful in large, integrated care settings. Before implementing the CDS, we will ask CHC patients and providers about the particular patient needs and perspectives and clinic workflows likely to influence adoption and impact of the CDS in CHCs. This input will inform development of CHC care team training strategies, and adaptation of the patient-facing aspects of the CDS system. We will measure adoption of the CDS, and impact of its use over time on CVD risk scores and risk factor control (blood pressure, HbA1c, lipid levels; aspirin use; smoking; body mass index) in high-CVD risk CHC patients. We will also conduct a mixed methods process evaluation, to identify facilitators and barriers to use of the CDS, and to iteratively develop and test strategies for supporting its adoption and ongoing use in CHC workflows. We anticipate that this intervention could (a) improve CVD care among low-income CHC patients, (b) reduce CVD care disparities between CHC populations and national rates, and (c) facilitate greater CHC patient engagement in CVD treatment decision-making and prioritization. The proposed work directly responds to PAR 15-279 goals: it addresses gaps in guideline- based care in high-risk populations with targeted, innovative, multi-level strategies; considers setting-specific needs; and supports patient engagement. Our team's research experience and established partnerships with key healthcare system stakeholders increase the likelihood of project success. Results will yield EHR- agnostic CDS tools for use by any CHC with an implementation guide, build knowledge about how to minimize disparities in CVD care and outcomes using scalable CDS strategies, and help translate investments in informatics into clinical benefit for millions of high-risk, low-income Americans.

项目总结/摘要：减少心血管疾病（CVD）的实质性进展 发病率和死亡率将实现，如果基于证据的指南，心血管疾病的危险因素控制， 在初级保健环境中持续实施。基于电子健康记录（EHR）的临床决策 支持（CDS）系统，识别不受控制的CVD风险因素并提供个性化护理 建议提高了大型综合医疗机构中指南一致性CVD护理的比率， 但是对于这种CDS在安全网社区卫生中心（CHC）中的有效性知之甚少。 社区卫生中心的社会经济弱势患者的心血管疾病风险因素控制更差， 心血管事件发生率高于一般人群。实施CDS可改善CVD风险因素 控制CHC可以减少CVD结果的国家差异，但CHC很少有资源 开发复杂的CDS，目前很少有这样的系统用于CVD护理。拟定研究 旨在解决这一问题。我们将60个共享EHR的CHC随机分为即时和延迟 实施复杂的CDS系统，提供床旁CVD护理建议， 初级保健提供者和病人，并已被证明是非常成功的大型综合护理 设置.在实施CDS之前，我们将询问CHC患者和提供者有关特定患者的信息 需求和观点以及可能影响CDS在CHC中的采用和影响的临床工作流程。 这一输入将告知CHC护理团队培训策略的制定，以及面向患者的 CDS系统的一部分。我们将衡量CDS的采用情况，以及随着时间的推移其使用对CVD的影响 风险评分和风险因素控制（血压、HbA 1c、血脂水平;阿司匹林使用;吸烟;体重 指数）。我们还将进行混合方法流程评估，以确定 促进者和使用CDS的障碍，并迭代开发和测试支持其 在CHC工作流程中采用和持续使用。我们预计，这种干预可以（a）改善心血管疾病的护理 在低收入的CHC患者中，（B）减少CHC人群和国家之间的CVD护理差异 率，和（c）促进更多的CHC患者参与CVD治疗决策， 优先化。拟议的工作直接响应PAR 15-279目标：它解决了准则中的差距， 在高风险人群中提供有针对性的、创新的、多层次的护理; 需要;并支持患者参与。我们团队的研究经验和建立的合作伙伴关系， 关键的医疗保健系统利益相关者增加了项目成功的可能性。结果将产生EHR- 不可知CDS工具，供任何CHC使用，并附有实施指南，了解如何 使用可扩展的CDS策略最大限度地减少CVD护理和结果的差异，并帮助翻译 信息学投资转化为临床效益为数百万高风险，低收入的美国人。

项目成果

Challenges involved in establishing a web-based clinical decision support tool in community health centers.

在社区卫生中心建立基于网络的临床决策支持工具所涉及的挑战。

• DOI: 10.1016/j.hjdsi.2020.100488
• 发表时间: 2020-12
• 期刊: Healthcare (Amsterdam, Netherlands)
• 作者: Gold R;Middendorf M;Heintzman J;Nelson J;O'Connor P;Sperl-Hillen J;Appana D;Geissal E;Thirumalai V;Sheppler C;Dunne M
• 通讯作者: Dunne M

Priorities Wizard: Multisite Web-Based Primary Care Clinical Decision Support Improved Chronic Care Outcomes with High Use Rates and High Clinician Satisfaction Rates.

• DOI: 10.5334/egems.284
• 发表时间: 2019-04-03
• 期刊: EGEMS (Washington, DC)
• 作者: Sperl-Hillen, JoAnn M;Rossom, Rebecca C;O'Connor, Patrick J
• 通讯作者: O'Connor, Patrick J

Adoption of shared decision-making and clinical decision support for reducing cardiovascular disease risk in community health centers.

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。

• DOI: 10.1093/jamiaopen/ooad012
• 发表时间: 2023-04
• 期刊: JAMIA open
• 影响因子: 2.1

Pandemic-related practice changes and CVD risk management in community clinics.

社区诊所中与流行病相关的实践变化和心血管疾病风险管理。

• DOI: 10.37765/ajmc.2024.89485
• 发表时间: 2024
• 期刊: The American journal of managed care
• 作者: Sheppler,ChristinaR;Larson,AnnieE;Boston,David;O'Connor,PatrickJ;Cook,Nicole;McGrath,BrendaM;Stange,KurtC;Gold,Rachel
• 通讯作者: Gold,Rachel

Effect of Clinical Decision Support at Community Health Centers on the Risk of Cardiovascular Disease: A Cluster Randomized Clinical Trial.

• DOI: 10.1001/jamanetworkopen.2021.46519
• 发表时间: 2022-02-01
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Gold R;Larson AE;Sperl-Hillen JM;Boston D;Sheppler CR;Heintzman J;McMullen C;Middendorf M;Appana D;Thirumalai V;Romer A;Bava J;Davis JV;Yosuf N;Hauschildt J;Scott K;Moore S;O'Connor PJ
• 通讯作者: O'Connor PJ