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

评估门诊胸痛患者是一个具有挑战性和严重的 问题，占所有门诊就诊的很大比例。高风险患者可以 未检测到，导致急性心肌缺血的漏诊，而低风险患者 可能会受到不必要的评估。大幅度改进评价工作， 治疗门诊急性胸痛综合征患者，需要制定新的策略 在初级保健环境中，对有症状的患者进行风险分层，并指导适当的护理。 这项研究将实施和评估电子风险警报的风险分层门诊病人 胸痛，并将此信息提供给初级保健临床医生， 电子健康记录干预将在哈佛先锋医疗公司内部进行 联营公司，一个多专业综合小组的做法与140初级保健医生照顾 在马萨诸塞州东部的14个中心为大约30万名患者提供治疗。随机， 对照研究设计，研究有三个具体目标： 1)确定风险适当的评估和治疗患者的预测因素， 急性胸痛的初级保健办公室，包括种族和性别。 2)为了确定是否有适当的评估和治疗急性 胸痛可以通过使用即时电子风险警报来改善， 提供个体患者的心脏风险概况和定制的评估和治疗 给初级保健医生的建议。 3)为以下患者提供电子决策支持进行成本分析： 急性胸痛。 这项研究对于确定门诊患者的治疗方法具有重要意义。 胸痛综合征可以通过电子决策的创新使用进行优化 支持，同时记录此类战略的成本影响。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患者风险信息，以提高患者安全性 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.