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Article Title

A Clinical Decision Support System Promotes Shared Decision-Making and Cardiovascular Risk Factor Management

Publication Date

8-10-2017

Keywords

clinical decision-making, patient experience/satisfaction

Abstract

Background: CV Wizard is a web-based electronic health record-integrated point-of-care clinical decision support (CDS) system that presents personalized cardiovascular (CV) risk information to providers and patients in both a low numeracy visual format and a high numeracy quantitative format. Herein we report primary care provider perspectives on how this CDS system affected shared decision-making and CV risk factor management.

Methods: Twenty clinics were randomized to either usual care or use of the CDS system for adults with diabetes, heart disease or high reversible CV risk. The CDS system targeted 20% of office visits and was used at 70%–80% of targeted visits over a 2-year period. Consented providers (n = 102) were surveyed at baseline and 18 months after implementation. Corrected survey response rates were 90% at baseline and 82% at follow-up. Generalized linear mixed models were used to compare usual care and CDS responses to common questions at baseline and follow-up, and CDS users were queried on their perceptions of the CDS system at follow-up only.

Results: Compared to usual care providers, those in the CDS group reported increased follow-up rates of CV risk calculations while seeing patients (73% vs 28%, P = 0.006), being better prepared to discuss CV risk reduction priorities with patients (98% vs 78%, P = 0.03), providing accurate advice on aspirin for primary prevention (75% vs 48%, P = 0.02), and more often discussing CV risk reduction (60% vs 30%, P = 0.06). CDS users reported that the CDS system improved CV risk factor control (98%), saved time when talking to patients about CV risk reduction (93%), efficiently elicited patient treatment preferences (90%), was useful for shared decision-making (95%), influenced treatment recommendations (89%) and helped initiate CV risk discussions (94%); 85% of providers reported that their patients liked CV Wizard.

Conclusion: The CV Wizard CDS system was successfully integrated into the workflow of primary care visits with high sustained use rates, high primary care provider satisfaction, high patient satisfaction, and positive impacts on provider-reported clinical processes related to CV risk factor management.

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