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

项目摘要/摘要：在减少心血管疾病方面取得实质性进展 如果心血管疾病风险因素控制的循证指南是 在初级保健环境中一致实施。基于电子健康档案的临床决策 识别不受控制的心血管疾病风险因素并提供个性化护理的支持(CDS)系统 建议提高了大型综合医疗保健环境中符合指南的心血管疾病护理比率， 但人们对这种CDS在安全网社区卫生中心(CHCs)的效果知之甚少。 CHC的社会经济脆弱患者的CVD危险因素控制率要差得多， 重大心血管事件多于普通人群。实施CDS可改善心血管疾病风险因素 对CHC的控制可以减少各国在心血管疾病结局方面的差异，但CHC很少有资源来 开发复杂的CDS，目前很少有这样的系统用于心血管疾病护理。建议的研究是 旨在解决这一问题。我们将使用共享的EHR将60个CHC随机分为立即和延迟 实施复杂的CDS系统，向以下人员提供护理点心血管疾病护理建议 初级保健提供者和患者，并已被证明在大型综合保健中非常成功 设置。在实施CDS之前，我们会询问CHC患者和提供者有关特定患者的情况 需求和观点以及临床工作流程可能会影响疾病预防控制系统在社区卫生控制中心的采用和影响。 这一意见将有助于CHC护理团队培训策略的制定，以及面向患者的适应 CDS系统的一些方面。我们将衡量CDS的采用情况，以及随着时间的推移使用CDS对心血管疾病的影响 风险评分和风险因素控制(血压、糖化血红蛋白、血脂水平；阿司匹林使用；吸烟；体重 (指标)在高心血管风险CHC患者中。我们还将进行混合方法的过程评估，以确定 使用CDS的促进者和障碍，并反复开发和测试支持ITS的战略 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人群和国家之间的心血管疾病护理差距 (C)促进慢性丙型肝炎患者更多地参与心血管疾病治疗决策和 确定优先顺序。拟议的工作直接回应了标准15-279的目标：它解决了准则- 在高危人群中以有针对性的、创新的、多层次的战略为基础的护理；考虑具体环境 需求；并支持患者参与。我们团队的研究经验和与 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- 不可知的CDS工具，供任何具有实施指南的CHC使用，构建有关如何 使用可扩展的CDS策略将CVD护理和结果方面的差异降至最低，并帮助转换 对信息学的投资使数百万高风险、低收入的美国人受益于临床。

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.