AUTOMATED CARDIAC DECISION SUPPORT SYSTEM IMPROVES CARE

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DESCRIPTION (provided by applicant): Cardiovascular disease continues to be the leading cause of mortality and morbidity in the United States. To assist health care practitioners in their integration of new information into clinical practice, professional organizations such as the National Cholesterol Education Program Expert Treatment Panel (ATP III), American Heart Association (AHA), American College of Cardiology (ACC), and Expert Treatment Panel (ATP III), Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), develop guidelines to promote evidence-based standards of care in the management of Cardiovascular disease. Despite the comprehensive nature and widespread dissemination of these guidelines, target parameters are not being achieved, and patients are not managed optimally. These diseases include achievement of lipid and blood pressure goals, usage of antiplatelet or anticoagulant therapy in patients with coronary artery disease and atrial fibrillation, usage of beta-blockers in patients post myocardial infarction, and the usage of beta-blockers and converting enzyme inhibitors in patients with systolic left ventricular dysfunction. To facilitate the incorporation of these treatment guidelines in everyday medical practice, the Cardiac Goal Program software has been developed to prompt entry of data essential to the management of cardiovascular disease, based on Class I or Grade A recommendations using established guidelines, into standardized, computerized forms with a reminder system. Our Phase I proposal focuses on the linking of two hospitals' computerized laboratory information system to our Cardiac Goal Program, thereby "automating" a substantial part of the data entry process and significantly reducing the time and effort required for data entry. The aims of this Phase II proposal are to evaluate the revised software in a multi-site clinical trial to assess whether the software improves the quality of care across the cardiovascular continuum, from heart failure to coronary artery disease to atrial fibrillation. We will also employ usability methodologies, including in-depth interviews and focus groups with physicians, nurses, and physicians' assistants, and refine the existing software based on the feedback from the practitioners and retest the feasibility. If this automated clinical information and decision support system is successful and widely implemented, the best outcomes from care for chronic cardiovascular disease may be achieved.