Physicians Voluntarily Using an EHR-Based CDS Tool Improved Patients' Guideline-Related Statin Prescription Rates: A Retrospective Cohort Study

Abstract Background  In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a revised guideline on statin therapy initiation. The guideline included a 10-year risk calculation based on regression modeling, which made hand calculation infeasible. Complianc...

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Bibliographic Details
Published in:Applied clinical informatics 2019-05, Vol.10 (3), p.421-445
Main Authors: Chang, Timothy S., Buchipudi, Ashwin, Fonarow, Gregg C., Pfeffer, Michael A., Singer, Jennifer S., Cheng, Eric M.
Format: Article
Language:English
Subjects:
Adult
Aged
Attitude to Computers
Cohort Studies
Decision Support Systems, Clinical
Drug Prescriptions - statistics & numerical data
Electronic Health Records - statistics & numerical data
Female
Guidelines as Topic
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Physicians - psychology
Physicians - statistics & numerical data
Research Article
Retrospective Studies
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Summary:Abstract Background  In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a revised guideline on statin therapy initiation. The guideline included a 10-year risk calculation based on regression modeling, which made hand calculation infeasible. Compliance to the guideline has been suboptimal, as many patients were recommended but not prescribed statin therapy. Clinical decision support (CDS) tools may improve statin guideline compliance. Few statin guideline CDS tools evaluated clinical outcome. Objectives  We determined if use of a CDS tool, the statin macro, was associated with increased 2013 ACC/AHA statin guideline compliance at the level of statin prescription versus no statin prescription. We did not determine if each patient's statin prescription met ACC/AHA 2013 therapy intensity recommendations (high vs. moderate vs. low). Methods  The authors developed a clinician-initiated, EHR-embedded statin macro command (“statin macro”) that displayed the 2013 ACC/AHA statin guideline recommendation in the electronic health record documentation. We included patients who had a primary care visit during the study period (January 1–June 30, 2016), were eligible for statin therapy based on the ACC/AHA guideline prior to the study period, and were not prescribed statin therapy prior to the study period. We tested the association of macro usage and statin therapy prescription during the study period using relative risk and mixed effect logistic regression. Results  Subjects included 11,877 patients seen in primary care, who were retrospectively recommended statin therapy at study initiation based on the ACC/AHA guideline, but who had not received statin therapy. During the study period, 125 clinicians used the statin macro command for 389 of the 11,877 patients (3.2%). Of the 389 patients for whom that statin macro was used, 108 patients (28%) had a statin prescribed during the study period. Of the 11,488 for whom the statin macro was not used, 1,360 (13%) patients received a clinician-prescribed statin (relative risk 2.3, p 
ISSN:1869-0327
1869-0327
DOI:10.1055/s-0039-1692186