Abstract 205: An Integrated Computer Decision Support Tool is Associated with Increased Frequency of Global Cardiovascular Risk Assessment

• Published in: Circulation Cardiovascular quality and outcomes Vol. 5; no. suppl_1
• Main Authors: Brown, Brian J, Tattersall, Matthew, Li, Zhanhai, Keevil, Jon
• Format: Journal Article
• Language: English
• Published: 01-04-2012
• ISSN: 1941-7713; 1941-7705
• DOI: 10.1161/circoutcomes.5.suppl_1.A205

Abstract only
Introduction:
Current guidelines recommend assessing global cardiovascular risk in all asymptomatic adults requiring primary prevention of coronary heart disease. Yet, physicians infrequently calculate risk, in part because use of global risk scores can be cumbersome.
Hypothesis:
We hypothesized that an auto populating Computer Decision Support Tool (CDST), providing point of care calculation of global cardiovascular risk, would improve clinical documentation of global risk.
Methods:
The HealthDecision CDST was launched on 02/01/2010 within the local electronic health record (EMR) at the University of Wisconsin Hospital and Clinics. Using a pre-post, matched case-controlled design, data was collected on all adult patients of 6 primary care physicians (PCP) for whom the CDST was used after EMR integration (2/1/2010-3/11/2011) and who also had a visit with the same PCP prior to CDST availability (1/1/2009-11/31/2010). Univariate and bivariate analyses of the cases identified the Framingham risk score (FRS) as a significant factor affecting change in risk documentation (p=0.0074). Control subjects with visits in the same time frames were individually matched 1:1 on PCP, age, gender, and FRS. Differences in pre-post risk documentation rates among cases and controls were analyzed using the McNemar’s test, while differences in risk documentation rates for matched cases and controls and differences among physicians were analyzed using the Fisher’s Exact test.
Results:
There were 61 patients for whom the CDST was used and had visits with the same PCP within the pre and post study periods. Clinic note documentation of the global risk score in patients for whom the CDST was used, was 3.3% (2/61) (95% CI 0.4-11.4%) before and 50.8% (31/61) (95% CI 37.7-63.9%) after CDST availability (p<0.0001). Risk documentation in the control group was 0% in both the pre and post periods. Risk documentation rates between the cases and controls in the pre CDST time period were not significantly different (p=0.50), while rates between the cases and the controls in the post CDST time period increased significantly The increase in risk documentation for cases from pre CDST to post CDST implementation was not dependent on the specific PCP (p=0.42).
Conclusion:
The use of an auto populating point of care CDST integrated into the EMR was associated with improved documentation of a global cardiovascular risk score.