Clinical Decision Support Tool May Improve Community Health, CVD Risk

The use of clinical decision support health IT could improve the reversible risk of cardiovascular disease (CVD) in community health center patients, according to a study published in JAMA Network Open.

The cluster-randomized clinical trial included 70 community health centers. Researchers activated a clinical decision support system (CDSS) called CV Wizard for use among an intervention group of 42 clinics. The CDSS system ran invisibly in 28 control clinics to collect data without giving access to the tool.

Overall, the use of the CDSS did not improve CVD risk at the population level.

However, CDSS use was associated with improved reversible risk of CVD among patients with the highest levels of baseline risk. Reversible risk decreased by 4.4 percent among high-risk patients at clinics with access to the tool compared to a 2.7 percent reduction in reversible risk at control clinics.

The authors noted that although the risk reduction was relatively small, it could contribute to a population-level reduction in cardiovascular events if maintained over time.

Additionally, the researchers pointed out that clinicians used the health IT in less than 20 percent of all eligible encounters.

Previous studies examined the use of the CDSS in primary care settings and found that PCPs used the CDSS at 70 to 80 percent of targeted encounters. The intervention helped improve glucose levels and BP control in adults with diabetes, as well as BP management in patients aged six to 18 years.

Factors that affect point-of-care CDSS use include workflow integration, competing clinical demands, and clinician confidence in the advice provided, the study authors said.

“The present study included numerous care organizations in which heterogeneity in rooming protocols impeded training and sustained high CDSS use,” they wrote. “Future studies should identify strategies for increasing CDSS use in community health centers. Analyses designed to understand CDSS adoption in this setting will be presented in future reports.”

The study authors noted several limitations to their research.

“In this cluster randomized clinical trial, randomization accounted for organization size, but could not balance on other characteristics, so analyses controlled for baseline factors likely to affect outcomes,” they wrote. “Other variables may have affected outcomes.”

The researchers also pointed out that while the CDSS tool supports both clinical decision support and shared decision-making, their analyses did not assess which elements clinicians used.

“Similarly, even if the tool’s output was viewed or printed, we do not know how it was used to engage individual patients; however, further analyses are underway,” they said. “Despite limitations, these results provide preliminary evidence that this technology has the potential to improve clinical care among community health center patients with high CVD risk.”