Preference-based care tool: Using HIT to integrate patient choice into primary care CVD management

Background:A critical component of patient-centered chronic disease care is educating patients about, and eliciting their preferences for, treatment options. Primary care physicians frequently do not have the time or expertise to elicit, evaluate, and use such information during an encounter. Purpose/objectives:We piloted the Preference-Based Care Tool (PBCT), a web-based application that educates patients about their cardiovascular disease (CVD) risk factors and elicits treatment preferences. Methods:Upon arrival at a clinic, eligible patients complete a web-based behavioral risk factors questionnaire; a 10-year heart attack relative risk is calculated in real-time using EHR/questionnaire data. Patients with a relative risk >1.1 are randomized to a PBCT or control group. Patients in the PBCT group immediately see the PBCT that presents the following: 1) patient-specific CVD risk factors; 2) an interactive, risk factor-specific “menu” of options to decrease risk or to “do nothing;” and 3) how risk changes as based on selected options. Patients “build” their care plan by selecting from the menu of options; patient preferences are then available to be accessed during the encounter by the physician via an EHR alert. Results:To date, 74 patients completed the PBCT; elevated LDL (n=73), BMI (n=72), and blood pressure (n=66) were the most common risk factors. Lifestyle interventions (e.g., dietary changes/exercise) were selected by > 60% of patients with elevated BP, BMI and LDL. A significant minority of at-risk patients in each risk factor category selected “do nothing” as their choice for reducing risk. Adding/changing a medication was selected by < 20% of BP, BMI and LDL patients. Discussion:Although medication is often the best practice recommendation for risk factor management, we observed that patient choice is frequently not concordant. By systematically educating patients and identifying their preferences, the PBCT allows the physician to design a care plan that balances guideline recommendations with patient preferences.