Shared Electronic Vascular Risk Decision Support in Primary Care

Abstract

Despite favorable reviews and important improvements in the complex processes required to reduce vascular risk, clinical outcomes remain unchanged.

Clinical Decision Support Systems and Prevention

“…Twenty-six studies were from the U.S., 24,25,28,29,31,34,36,39,44,45,47,51–54,56,58,63,65,67,80–82,84,85,87 with the remaining studies conducted in Canada (five studies) 41,48,61,66,83 ; Europe (11 studies) 26,27,30,33,37,38,42,46,50,67,68 ; Australia (two studies) 32,60 ; and New Zealand (one study). 43 Most studies implemented CDSSs in outpatient practices; two studies 54,55 were in a hospital setting.…”

“…CDSS users were usually physicians (39 studies), 24–26,28,29,31,33,34,36–39,41,43–48,50–56,58,61,63,65–68,81–85,87 followed by nurses (12 studies) 24–26,29,36,41,45,47,50,61,63,84 ; physician assistants (five studies) 24,25,31,36,45 ; and pharmacists (two studies). 51,60 Most interventions used locally developed CDSSs (24 studies), 24,25,27,28,31,37–39,44–48,51,54,55,58,61,63,65,66,83,85,87 and were integrated within EHRs (29 studies). 24,28–30,32–34,37–39,42,43,46,50–52,54–56,63,66–68,80,82–85,87 Decision support was usually delivered to the clinician synchronously during patient visits (38 studies), 24–28,30,33,34,36–39,41–44,46,48,51–…”

“…From studies that reported race/ethnicity, the median for the proportion of study populations identifying as white was 58.5% (14 studies) 24–26,29,36,39,45,48,53–55,81,85,87 and 47.5% for participants identifying as black (nine studies). 24,25,29,39,51,53,58,81,87 Few studies reported income level, 45 education attainment, 31,41,45,51,83 or insurance status. 31,36,39,53,83,87 …”

“…24,25,29,39,51,53,58,81,87 Few studies reported income level, 45 education attainment, 31,41,45,51,83 or insurance status. 31,36,39,53,83,87 …”

Is Clinical Decision Support the Missing Link in Prevention?

“…Holbrook and colleagues’ study (2), however, contributes to a growing body of evidence suggesting that CDS is not the magic bullet that many proponents envision. While numerous reports from flagship institutions indicate that CDS can have a measurable impact on local health care quality (3, 4), most studies with a broader focus suggest that CDS has a limited impact on improving health in more conventional settings (5, 6).…”