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

基于电子健康记录的仪表板驱动的干预措施，以改善心血管疾病预防性护理的识别和管理

• 批准号: 10238854
• 负责人: James Brian Jones
• 金额: $ 25.91万
• 依托单位: CALIFORNIA PACIFIC MED CTR RES INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10238854
• 关键词: Adoption; Adult; Affect; African American; Age; Area; Aspirin; Blood Pressure Monitors; Cardiovascular Diseases; Caring; Chronic; Clinic; Clinical; Cluster randomized trial; Code; Communication; Counseling; Development; Diabetes Mellitus; Diet; Effectiveness; Electronic Health Record; Elements; Engineering; Ethnic Origin; Geography; Goals; Guidelines; Health Benefit; Health Services Accessibility; Health education; Healthcare Systems; Hyperlipidemia; Hypertension; Incidence; Intervention; Learning; Life Style; Names; Patient Care; Patient Education; Patients; Persons; Pharmaceutical Preparations; Phase; Physical activity; Physicians; Prevention; Preventive; Preventive care; Primary Care Physician; Primary Health Care; Process; Qualitative Methods; Race; Randomized Controlled Trials; Recommendation; Research; Risk; Risk Estimate; Risk Factors; Running; Site; Smoking; System; Technology; Testing; Time; Translating; Treatment Efficacy; United States; Variant; Visit; Work; age group; base; burden of illness; burnout; cardiovascular disorder risk; cardiovascular risk factor; care providers; cost; dashboard; design; digital; efficacy evaluation; ethnic minority population; follow-up; group intervention; health disparity; health literacy; health management; health seeking behavior; improved; literacy; member; mortality; non-compliance; operation; patient engagement; point of care; population health; prevent; primary care setting; provider factors; racial minority; randomized trial; screening; shared decision making; smoking cessation; systems research; tool; unhealthy lifestyle

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.

心血管疾病（CVD）是美国和世界上死亡的主要原因，以及 是最昂贵的慢性病之一。与年轻人相比 年龄，在此之后的每个十年中增加了50％或更多，也与种族和 种族。尽管USPSTF指南建议使用与CVD相关的预防性护理，但仅小于 有40％的风险患者及时完成其中一种预防性关心。该项目的目的是开发， 实施并评估基于电子健康记录（EHR）的预防保健仪表板管理 基于工具和团队的干预措施，以提高CVD相关的预防性护理的基础护理 患者50岁以上。提出的仪表板无缝集成在电子健康中 记录（EHR）至：（a）确定具有CVD风险的成年人； （b）建议个性化CVD相关的预防性 组件和相关的行动建议（例如筛查测试顺序，药物订单等） 与初级保健提供者的临时访问； （c）与人口健康管理团队互动 访问。开发和试点测试将在R61阶段进行。在R33阶段，我们严格测试 使用〜200个初级保健医生的簇随机对照试验的工具的影响，并评估 干预对有CVD风险的患者的4个关键预防护理元件的完成影响：（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） 适当的阿司匹林和他汀类药物的使用。干预措施，称为CVD预防护理仪表板 管理（CVD-PCDM）工具，提供特定于患者和临床医生特定的CVD预防保健 针对初级保健提供者（PCP）和患者的建议和风险估算 每次初级保健遇到，以促进共同的决策和患者教育。这个CVD-PCDM将 使用成功的数字解决方案开发和测试周期与临床医生共同设计 在Sutter运行的其他类似仪表板系统中进行了测试，并在初级保健诊所实施。 CVD-PCDM的可伸缩性将首先在Sutter中进行两个地理和种族不同 操作单位。同时，我们还将从医疗系统研究中确定一个医疗保健系统 网络（HCSRN）复制干预措施并评估效果。 HCSRN由大型医疗保健组成 美国的系统，并积极促进了协作研究。如果CVD-PCDM在Sutter上有效 代码和开发包将与第二个站点共享。我们将设计一个数字解决方案 可扩展的管道可以迅速且一致地将基于指南的预防保健转化为 在初级保健环境中提供个性化和协调的CVD护理。