• David Boston, Annie E Larson, Christina R Sheppler, Patrick J O'Connor, JoAnn M Sperl-Hillen, Jennifer Hauschildt, and Rachel Gold.
• From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH). bostond@ochin.org.
• J Am Board Fam Med. 2023 Oct 11; 36 (5): 777788777-788.

PurposeTo assess the impact of a clinical decision support (CDS) system's recommendations on prescribing patterns targeting cardiovascular disease (CVD) when the recommendations are prioritized in order from greatest to least benefit toward overall CVD risk reduction.MethodsSecondary analysis of trial data from September 20, 2018, to March 15, 2020, where 70 community health center clinics were cluster-randomized to the CDS intervention (42 clinics; 8 organizations) or control group (28 clinics; 7 organizations). Included patients were medication-naïve and aged 40 to 75 years with ≥1 uncontrolled cardiovascular disease risk factor, with known diabetes or cardiovascular disease, or ≥10% 10-year reversible CVD risk.ResultsAmong eligible encounters with 29,771 patients, the probability of prescribing a medication targeting hypertension was greater at intervention clinic encounters when CDS was used (34.9% [95% CI, 31.5 to 38.3]) versus dismissed (29.6% [95% CI, 26.7 to 32.6]; P < .001), but not when compared with control clinic encounters (34.9% [95% CI, 31.1 to 38.7]; P = .998). Prescribing for dyslipidemia was significantly higher at intervention encounters where the CDS system was used (11.3% [95% CI, 9.3 to 13.3]) compared with dismissed (7.7% [95% CI, 6.1 to 9.3]; P = .003) and to control encounters (8.7% [95% CI, 7.0 to 10.4]; P = .044); smoking cessation medication showed a similar pattern. Except for dyslipidemia, prescribing rates increased according to their prioritization.ConclusionsUse of this CDS system was associated with significantly higher prescribing targeting most cardiovascular risk factors. These results highlight how displaying prioritized actions to reduce reversible CVD risk could improve risk management.Trial RegistrationClinicalTrials.gov, NCT03001713, https://clinicaltrials.gov/.© Copyright by the American Board of Family Medicine.

18 keywords...

hide…