Impact of Decision Support in Electronic Medical Records on Lipid Management in Primary Care

Abstract

Electronic decision-support tools may help to improve management of hyperlipidemia and other chronic diseases. This study examined the impact of lipid management tools integrated into an electronic medical record (EMR) in primary care practices. This randomized controlled trial was conducted in a national network of physicians who use an outpatient EMR. Adult primary care physicians were randomized by office to receive an electronic form that was embedded in the EMR. The form contained prompts regarding suboptimal care based on Adult Treatment Panel-III (ATP-III) guidelines, as well as reporting tools to identify patients outside of office visits whose lipid management was suboptimal. All active patients, ages 20-79 years, whose physicians participated in the study, were categorized as high, moderate, or low cardiovascular risk, and the proportion who were tested for hyperlipidemia, at lipid goal, and on lipid-lowering medications if not at goal were measured according to ATP-III guidelines. A total of 105 physicians from 25 offices and 64,150 patients were included in the study. Outcomes improved for most measures from before to 1 year after the intervention (November 1, 2005 to October 31, 2006). However, after controlling for confounding variables and for clustering in multilevel modeling, only up-to-date lipid testing for high-risk patients was statistically better in the intervention group as compared to the control group (adjusted odds ratio 15.0, P < 0.05). This study showed few differences in quality of lipid management after implementing an EMR-based disease management intervention in primary care settings. Future studies may need to examine more comprehensive interventions that include office staff in a team approach to care.

Impact of EHR-Based Clinical Decision Support on Adherence to Guidelines for Patients on NSAIDs: A Randomized Controlled Trial

“…14,41 Several studies have found benefi ts for diabetes care, 12,[42][43][44][45] appropriate prescribing for patients with hypertension, 46 and management of osteoporosis. 47 But other studies have not found benefi ts for diabetes care 48 ; management of hypertension, 49 hyperlipidemia, 13 and other cardiovascular diseases 12 ; or management of depression. 10 A systematic review of studies examining the impact of clinical decision support on prescribing behavior found mixed results.…”

“…9 Although it makes sense that clinical decision support should have a similar effect in primary care offi ces, many studies have not found that to be the case, particularly for chronic conditions. [10][11][12][13] A systematic review of the impact of EHRs found that EHR-based clinical decision support has a positive impact mainly for preventive care rather than chronic disease care. 14 Another systematic review that focused specifi cally on the impact of clinical decision support for prescribing behavior found mixed results, with positive results mainly for avoiding inappropriate prescriptions based on age alone, rather than on a more complex array of medical conditions.…”

“…The data are cleaned, standardized, deidentifi ed, and put into a central data repository. This repository is used by CHURN for prospective studies to improve quality of care 13 ; by MQIC members for monitoring quality of care at the practice level; by researchers conducting retrospective studies on quality of care [16][17][18][19] ; and for national surveillance and other purposes. Only MQIC members who agree to participate in prospective studies on quality of care are members of CHURN.…”

Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

“…Other studies (17,43,53,41,54,7,55) assessed the use of CAHTS on cardiovascular disease prevention and management, but these either did not compare oral to written history taking processes or were conducted in participants who did not have pre-existing cardiovascular disease. In line with our review they generally commented that computer-assisted methods improved the management of patients with cardiovascular disease or with risk factors for cardiovascular disease.…”

“…If the diabetes can be improved with computer-assisted history taking this consequently impacts on the prevention of cardiovascular disease. Gill et al (2009) found improved outcomes in patients at high-risk of cardiovascular disease when an electronic form containing prompts regarding sub optimal care was integrated into the electronic medical record. The 3 main outcome variables were defined accordingly: the proportion of patients tested adequately for hyperlipidaemia, the proportion of patients whose most recent low-density lipoprotein cholesterol (LDL-C) was at goal, and the proportion of patients at high risk of cardiovascular disease with an LDL-C > 130 who were prescribed lipid-lowering medications.…”