An Electronic Health Record based Dashboard-driven Intervention to Improve Identification and Management of Preventive Care for Cardiovascular Disease

心血管疾病（CVD）是美国和世界上死亡率的主要原因， 是最昂贵的慢性病之一。与年轻人相比，40-50岁的心血管疾病发病率增加了两倍 年龄，并在此后的每十年增加50%或更多，也与种族密切相关， 种族尽管USPSTF指南推荐了CVD相关的预防护理，但只有不到 40%的高危患者及时完成其中一项预防性护理。该项目的目标是开发， 实施和评估基于电子健康记录（EHR）预防保健仪表板管理 工具和基于团队的干预，以提高初级保健CVD相关预防性护理的依从性 50岁及以上的患者。建议的仪表板无缝集成在电子健康 记录（EHR）：（a）识别有CVD风险的成年人;（B）建议个性化的CVD相关预防措施 组件和相关的行动建议（例如，筛选检查订单、药物订单等）在 与初级保健提供者进行定点保健访问;（c）让人口健康管理小组参与， 探访开发和中试将在R61阶段进行。在R33阶段，我们严格测试 该工具的影响使用了一项有约200名初级保健医生参加的群集随机对照试验， 干预对心血管疾病高危患者完成4项关键预防保健要素的影响：（1）糖尿病 筛查，（2）血压监测;（3）生活方式（戒烟、饮食和体育活动）;（4） 适当使用阿司匹林和他汀类药物。干预，称为CVD预防保健仪表板 管理（CVD-PCDM）工具，提供患者特定和临床医生特定的CVD预防护理 以低识字率格式向初级保健提供者（PCP）和患者提供建议和风险评估， 每一次初级保健接触，以促进共同决策和病人教育。该CVD-PCDM将 与临床医生共同设计，使用成功的数字解决方案开发和测试周期， 在Sutter目前运行的其他类似仪表板系统中进行了测试，并在初级保健诊所中实施。 CVD-PCDM的可扩展性将首先在两个地理和种族不同的Sutter内进行测试， 操作单元。同时，我们亦会从医疗系统研究中找出一个医疗系统 网络（HCSRN）复制干预措施并评估效果。HCSRN包括大型医疗保健 在美国，我们积极推动合作研究。如果CVD-PCDM在萨特有效， 有关守则及发展配套将与第二个地点共用。我们将设计一个数字解决方案 一个可扩展的管道，可以快速，一致地将这种基于指南的预防性护理转化为 在初级保健环境中提供个性化和协调的CVD护理。

Cardiovascular disease (CVD) is the leading cause of mortality both in the United States and in the world, and is one of the most costly chronic conditions. The incidence of CVD triples at age 40-50 compared to younger age, and increases 50% or more at each decade of age after that, is also strongly associated to race and ethnicity. Though CVD related preventive cares have been recommended by USPSTF guideline, only less than 40% at risk patients complete one of those preventive cares timely. The objective of the project is to develop, implement, and evaluate an electronic health record (EHR)-based preventive care dashboard management tool and team-based intervention to improve compliance of CVD related preventive care for primary care patients 50 years and older. The proposed dashboard is seamlessly integrated within the electronic health record (EHR) to: (a) identify adults with CVD risk; (b) suggest personalized CVD related preventive components and associated recommendations of action (e.g. screening test order, medication order, etc.) at point-of-care visit with primary care providers; and (c) engage population health management teams between visits. The development and pilot test will take place during R61 phase. In the R33 phase, we rigorously test the impact of the tool using a cluster randomized controlled trial with ~200 primary care physicians and assess intervention impact on completion of 4 key preventive care elements for patients at risk for CVD: (1) diabetes screening, (2) blood pressure monitoring; (3) lifestyle (smoking cessation, diet and physical activities); (4) appropriate aspirin and statin use. The intervention, referred to as CVD Preventive Care Dashboard Management (CVD-PCDM) tool, provides patient-specific and clinician-specific CVD preventive care recommendations and risk estimate in low-literacy format to the primary care provider (PCP) and patients at each primary care encounter to facilitate shared decision making and patient education. This CVD-PCDM will be co-designed with clinicians using a successful digital solution development and test cycle which has been tested in other similar dashboard systems current running at Sutter, and implemented in primary care clinics. Scalability of the CVD-PCDM will be first tested within Sutter in two geographically and racially distinct operation units. Meanwhile, we will also identify one health care system from Health Care System Research Network (HCSRN) to duplicate the intervention and assess the effect. HCSRN consists of large health care systems in the US, and has actively promoted collaborative research. If the CVD-PCDM is effective at Sutter, the codes and development package will be shared with the second site. We will design a digital solution scalable pipeline that can be rapidly and consistently translates this guideline-based preventive care into delivery of personalized and coordinated CVD care within primary care settings.