Abstract
Background: The risk of cardiovascular events is reduced through the optimal management of serum lipids, blood pressure, smoking, weight, physical activity and other established risk factors. To bridge the gap between knowledge and practice, we tested an electronic health record (EHR)-based prototype care model to routinely screen for and manage cardiovascular disease (CVD) risk.
Methods: We developed and tested automated protocols to accomplish six tasks:
identifying patients who should be evaluated for risk of CVD using a modified Framingham Risk Score at the point of care;
ordering appropriate tests leveraging routine physician visits;
determining 5-year risk of heart attack;
communicating risks to patients via automated letters from physicians;
engaging those at moderate to high risk of heart attack to modify behavior; and
providing physicians with clinical decision support (CDS).
Results: The prototype care model was evaluated on 346 patients. Steps 1 through 4 were successfully implemented. Step 5, engaging patients in behavior change, was too limited and did not provide the patient with sufficient control over various options. Step 6, providing CDS, presented physicians with 1 of 43 fixed order sets. A more dynamic and flexible order process was needed to satisfy physician needs.
Conclusions: This prototype care model presents a successful first step toward automating screening and basic care of chronic diseases while focusing care on a patient-centered model. The problems revealed through this system were largely process challenges.
- Received September 11, 2008.
