Sequist:Can Risk Score Alerts Improve Office Care for Chest Pain?

对门诊胸痛患者的评估是一项具有挑战性和严肃性的工作 问题，占所有门诊就诊的很大比例。高危患者可能会去 未被发现，导致漏诊急性心肌缺血，而低风险患者 可能会受到不必要的评估。要大幅改进评估，并 急性胸痛综合征门诊患者的治疗，需要开发新的策略 在初级保健环境中，对有症状的患者进行风险分层，并直接进行适当的护理。 这项研究将实施和评估电子风险警报，以对门诊患者进行风险分层 并在以下情况下向初级保健临床医生提供此信息 电子健康记录。干预将在哈佛先锋医疗公司内部进行 Associates，一个多专科综合团体诊所，由140名初级保健医生提供护理 为马萨诸塞州东部14个中心的约300,000名患者提供服务。随机化的， 对照研究设计，该研究有三个具体目标： 1)确定风险适宜性评估和治疗的预测因素 初级保健办公室有急性胸痛，包括种族和性别。 2)确定急性呼吸窘迫综合征患者的适当评估和治疗率 胸痛可以通过使用护理点电子风险警报来改善 提供个别患者的心脏风险概况以及量身定做的评估和治疗 给初级保健临床医生的建议。 3)为符合以下条件的患者提供电子决策支持进行成本分析 急性胸痛。 这项研究对确定如何治疗门诊患者具有重要意义 有胸痛症状的患者可以通过创新使用电子决策来优化 支持，同时记录这一战略所涉费用问题。这项工作还将提供 全国各地的门诊实践如何使用电子健康记录的模型 向临床医生提供实时的患者风险信息，以提高患者的安全性 和质量，这对急性和慢性护理都有重要影响。

The evaluation of ambulatory patients with chest pain is a challenging and serious problem, accounting for a significant proportion of all outpatient visits. High risk patients may go undetected, resulting in missed diagnoses of acute myocardial ischemia, while low risk patients may be subject to unnecessary evaluations. To substantially improve the evaluation and treatment of outpatients with acute chest pain syndromes, new strategies need to be developed in the primary care setting to risk stratify symptomatic patients and direct appropriate care. This study will implement and evaluate electronic risk alerts to risk stratify outpatients with chest pain and present this information to primary care clinicians within the context of an electronic health record. The intervention will take place within Harvard Vanguard Medical Associates, a multispecialty integrated group practice with 140 primary care physicians caring for approximately 300,000 patients at 14 centers in eastern Massachusetts. With a randomized, controlled study design, the study has three specific aims: 1) To identify predictors of risk-appropriate evaluation and treatment of patients presenting to primary care offices with acute chest pain, including race and sex. 2) To determine whether rates of appropriate evaluation and treatment of patients with acute chest pain can be improved through the use of point-of-care electronic risk alerts that provide individual patient cardiac risk profiles and tailored evaluation and treatment recommendations to primary care clinicians. 3) To perform a cost analysis for the provision of electronic decision support for patients with acute chest pain. This study has important implications for determining how the treatment of outpatients with chest pain syndromes can be optimized through the innovative use of electronic decision support, while documenting the cost implications of such a strategy. This work will also provide a model for how ambulatory practices across the country can use electronic health records to present real-time patient risk information to clinicians with the goal of improving patient safety and quality, which has important implications for both acute and chronic care.