Reducing Cardiovascular Risk in Adults with SMI Using EMR-based Clinical Decisio

患有严重精神疾病(SMI)(精神分裂症、分裂情感障碍、双相情感障碍)的人死于25岁 比同龄人早几年，心血管疾病是主要的死亡原因。初级保健 提供商(PCP)通常没有意识到SMI患者的心血管风险显著增加，甚至 当心血管危险因素被识别时，通常不能提供适当的临床措施。电子医疗 在临床会诊时提供的基于记录(EMR)的临床决策支持(CDS)可能是一个强大的工具 帮助初级保健提供者(PCP)识别和控制SMI患者的心血管危险因素。 该计划将调整基于护理点EMR的CDS系统(CV向导)，以帮助PCP识别、提供 适当护理和控制SMI患者的心血管危险因素。简历向导旨在教育 关于SMI患者心血管疾病风险和死亡率增加的PCP，确定增加的心血管风险 SMI患者的因素，根据患者的心血管风险改善程度来确定这些心血管风险的优先顺序 如果简历风险因素得到充分解决，建议使用特定的药物，并 其他干预措施，以降低每个升高的CV风险因素，并以简单易懂的方式提供这一信息 适用于SMI患者及其PCP的表格。对于那些正在服用SMI的患者 与体重增加最相关的药物，他们将能够与精神病护理经理合作， 在患者治疗精神病医生的监督下，并在患者同意的情况下，将切换。 SMI药物与体重增加的相关性较小。这一干预的有效性将是 在一项临床随机试验中进行了评估，该试验有52家初级保健诊所、150名初级保健医生和大约2,250名患有 SMI。我们假设，相对于在对照诊所接受护理的SMI患者，CV中的患者 巫师诊所将有：(A)降低总的可修改简历风险；(B)更好地控制六个个人可修改简历 风险因素，包括血压、血脂、烟草使用、阿司匹林使用、肥胖/肥胖，以及 糖尿病，血糖控制，以及(C)最相关的SMI药物开药率较低 随着体重的增加。在二次分析中，我们还将探讨简历向导和关怀的影响 心血管危险因素识别、治疗启动和强化管理；用药依从性； 门诊和住院患者利用；有风险的处方事件；以及简历事件。 这项研究针对的是一个重要的研究领域，这是国家精神卫生研究所的优先事项- 我们的卫生系统合作伙伴和外部利益相关者顾问委员会；利用以前的基础设施 对精神健康研究网络的投资；并利用我们研究人员的专业知识。 制定有效的电子病历驱动的护理点CDS策略，以确定可用资源并确定其优先顺序 更好地解决患有SMI的成人心血管危险因素的治疗选择是关键的下一步 改善这一医疗服务不足人群的健康并降低其心血管疾病风险。

People with serious mental illness (SMI) (schizophrenia, schizoaffective disorder, bipolar disorder) die 25 years eariier than their peers, and cardiovascular (CV) disease is the leading cause of death. Primary care providers (PCPs) often are not aware of the significantly increased CV risk in patients with SMI and, even when CV risk factors are identified, appropriate clinical actions often are not provided. Electronic medical record (EMR)-based clinical decision support (CDS) delivered at a clinical encounter may be a powerful tool to help primary care providers (PCPs) identify and control CV risk factors in patients with SMI. This proposal will adapt a point-of-care EMR-based CDS system (CV Wizard) to help PCPs identify, provide appropriate care for, and control CV risk factors for patients with SMI. CV Wizard is designed to educate PCPs about the increased risk of CV disease and mortality in people with SMI, identify elevated CV risk factors in patients with SMI, prioritize these CV risks based on how much improvement in CV risk a patient would experience if the CV risk factor was adequately addressed, recommend specific medications and other interventions to decrease each elevated CV risk factor, and provide this information in an easy-tounderstand format for both patients with SMI and their PCPs. For those patients who are on the SMI medications most associated with weight gain, they will be able to work with a psychiatric care manager who, under the supervision of the patient's treating psychiatrist and with the consent of the patient, will switch the. SMI medication to one less associated with weight gain. The effectiveness of this intervention will be assessed in a clinic-randomized trial with 52 primary care clinics, 150 PCPs, and about 2,250 adults with SMI. We hypothesize that, relative to patients with SMI receiving care in control clinics, those in the CV Wizard clinics will have (a) reduced total modifiable CV risk; (b) better control of six individual modifiable CV risk factors, including blood pressure, lipids, tobacco use, aspirin use, ovenA/eight/obesity, and, for those with diabetes, glucose control, and (c) lower rates of prescriptions of SMI medications that are most associated with weight gain. In secondary analyses, we will also explore the impact of CV Wizard and care management on CV risk factor identification, treatment initiation and intensification; medication adherence; outpatient and inpatient utilization; risky prescribing events; and CV events. This study targets an important area of research that is a priority for the National Institute of Mental Health, - our health system partners, and our external stakeholder advisory board; leverages previous infrastructure investments in the Mental Health Research Network; and capitalizes on the expertise of our researchers. Developing an effective EMR-driven point-of-care CDS strategy that identifies and prioritizes available treatment options to better address uncontrolled CV risk factors in adults with SMI is a critical next step to improving the health and reducing the CV risk of this medically underserved population.