Prioritized Clinical Decision Support to Reduce Cardiovascular Risk

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). The
prioritized list of treatment options is provided in different formats to both the primary
care physician (PCP) and patient at the time of each office visit made by a patient with
moderate to high CVR and sub-optimally controlled and potentially reversible CVR factors.
Available evidence-based treatment options are prioritized based on the magnitude of
potential CVR reduction of each treatment option. This intervention strategy, referred to as
Prioritized Clinical Decision Support (PCS), is specifically designed for widespread use in
primary care settings and has the potential to substantially augment current efforts to
control CVR in the 35% of American adults with 10-year Framingham CVR of 10% or higher.

To assess the ability of the PCS intervention to reduce CVR in adults, we will randomize 18
primary care clinics with 60 primary care physicians (PCPs) and approximately 18,000 eligible
adults with baseline Framingham 10-year risk of a major CV event (either heart attack or
stroke) of 10% or more into one of two experimental conditions: Group 1 includes 9 clinics
(with 30 PCPs and 9,000 patients) that will receive prioritized clinical decision support
(PCS) to reduce CVR at the time of each clinical encounter made by an eligible adult. Group 2
includes 9 clinics (with 30 PCPs and 9,000 patients) that receive no study intervention and
constitute a usual care control group. The study will formally test the hypothesis that after
control for baseline CVR, post-intervention 10-year Framingham CVR will be better in Group 1
than Group 2 at 12 and 24 months after start of the intervention. In addition, impact of the
intervention on specific components of CVR (BP, lipids, glucose, aspirin use, and smoking)
will be assessed, and the cost-effectiveness of the intervention will be quantified.

This innovative project builds upon 10 years of prior work by our research team, and extends
prior successful EHR clinical decision support interventions by introducing prioritization,
by providing decision support to both patients and PCPs at the time of the office visit, and
by extending the decision support across the broad and critically important clinical terrain
of CVR reduction. The results of this project, whether positive or negative, will extend our
understanding of how to maximize the clinical return on massive public and private sector
investments now being made in sophisticated outpatient EHR systems. If successful, this
decision support tool could be broadly used to both standardize and personalize care
delivered by case managers, pharmacists, and other providers in a wide range of care delivery
configurations.

Inclusion Criteria:

- Practicing general internist or family physician at HealthPartners Medical Group
(HPMG)

- Provide ongoing care for 200 or more adult patients with 10 year CVR >=10%

Exclusion Criteria:

- PCP not practicing in HPMG clinic

- Patient age greater than 80 years

- Patient Charlson comorbidity score greater than 3