269598 Reaction of health professionals to chronic disease Clinical Decision Support (CDS)

Monday, October 29, 2012

Mary K. Goldstein, MD, MS , Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
Susana Martins, MD , Grecc 182B, VA Palo Alto Health Care System, Palo Alto, CA
James Schlosser, MD , Department of Veteran Affairs Bedford, Bedford, MA
Nancy Kim, MD , Yale University, New Haven, CT
Wildon Farwell, MD , ..., Brigham and Women's Hospital, Boston, MA
Tyson Holmes, PhD , Dept. of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA
Mark Musen, MD, PhD , Center for Biomedical Informatics Research, Stanford University, Stanford, CA
Samson Tu, MS , Bmir, Stanford University, Stanford, CA
Dallas Chambers, BS , Geriatric Research Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
Timothy Keng , Grecc, VA Palo Alto Health Care System, Palo Alto, CA
Brian Hoffman, MD , Dept of Medicine, Boston VA Medical Center, Boston, MA
Background: Clinical Decision Support (CDS) systems that provide health professionals with evidence-based care recommendations have the potential to improve patient-centeredness of care by individualizing recommendations for each patient; however, it is important to know whether health professionals find them useful and usable. We implemented ATHENA-Hypertension (ATHENA-HTN), a CDS for management of primary hypertension, to assist primary care providers (PCPs) in individualizing patient care.

Objective/Purpose: To evaluate the usefulness and usability of ATHNEA-HTN in a primary care clinical environment.

Methods: The 46 PCPs enrolled at 4 medical centers in the active intervention arm were asked to complete a post-intervention survey. 41/46 (89%) of these PCPs responded to the survey: 16 MDs, 24 NPs, and 1 PA. PCPs rated their experience in terms of the usefulness of the information provided, ease of understanding the information presented, and ease of using the system. Response options for survey questions were of 3 types: (1) “Very Useful”, “Useful”, “Not Useful”, “Don't Know/No Opinion”; (2) “Excellent”, “Good”, “Fair”, “Poor”; or (3) “Very Often”, “Often”, “Not Often”.

Results: Many PCPs reported that they found ATHENA-HTN to be “Useful” or “Very Useful” as a reminder to manage hypertension (34/41(83%)); to intensify treatment when the patient's BP was above target (34/41(83%)); and to consider thiazides as part of a multi-drug regimen (27/41(66%)). They reported that “Often” or “Very Often” information ATHENA-HTN presented was useful (29/40(73%)) and had an impact on their choice of treatment (18/39(46%)). The system was rated as having “Excellent” or “Good” readability (30/41(73%)), ease of navigation (27/41(66%)), and integration with overall clinical workflow (21/41 (51%)). PCPs also found the BP prescription graphs (21/37 (57%)) and the ability to enter in a new BP and update the advisory (19/39 (54%)) to be useful.

Discussion/Conclusions: CDS such as ATHENA-HTN can assist PCPs with providing evidence-based care to patients.

Learning Areas:
Chronic disease management and prevention
Clinical medicine applied in public health
Communication and informatics

Learning Objectives:
Participants will be able to explain the impact of clinical decision support (CDS) systems on primary care providers (PCPs), list CDS components that PCPs found helpful, and discuss how CDS can improve individualizing patient-centered care.

Keywords: Health Information Systems, Hypertension

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the PI of multiple federally funded grants on health information technology, particularly but not exclusively clinical decision support (CDS) for chronic disease. I have led studies that implemented CDS in multiple medical centers and evaluated the implementation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.