Purpose: The objective of this project is to develop and implement sophisticated point-of-care EHR-based clinical decision support that (a) identifies and (b) prioritizes all available evidence-based treatment options to reduce a given patient’s cardiovascular risk (CVR).
Background: More than 30% of adults in the U.S. have a 10-year risk of heart attack or stroke of 10% or greater using the Framingham CVR equations. National and local data both show that even among adults with overt cardiovascular (CV) disease, less than 50% simultaneously reached their evidence-based LDL and BP goals even as recently as 2007.
Methods: After developing the EHR-based decision support intervention, we will test its impact on CVR, the components of CVR, in a group randomized trial that includes 18 primary care clinics, 60 primary care physicians, and 18,000 adults with moderate or high CVR.
Significance: This approach, if successful, will (a) improve chronic disease outcomes and reduce CVR for about 35% of the U.S. adult population, (b) maximize the clinical return on investments that are increasingly being made in sophisticated outpatient EHR systems, and (c) provide a model for how to use EHR technology support to deliver “personalized medicine” in primary care settings. This innovative project builds upon 10 years of prior work by our team, and extends prior successful EHR clinical decision support interventions by introducing prioritization, by providing decision support to both patients and PCPs at the point of care, and by extending decision support across the broad and critically important clinical terrain of CVR reduction.