Development and pilot feasibility study of a health information technology tool to calculate mortality risk for
Adrienne E Faerber1, Rebecca Horvath2, Carey Stillman2
1The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, NH, USA.
Insights
The CArotid Risk Assessment Tool (CARAT) was integrated into electronic medical records to estimate stroke risk. This tool helps physicians assess patient mortality risk for better treatment decisions.
Area of Science:
- Vascular Surgery
- Health Informatics
- Clinical Decision Support
Background:
- Patients with carotid artery stenosis face increased stroke risk.
- Accurate risk assessment is crucial for guiding surgical or stenting interventions.
- Existing methods require estimating peri-operative outcomes and long-term survival benefits.
Purpose of the Study:
- To develop and integrate the CArotid Risk Assessment Tool (CARAT) into electronic medical records.
- To function as a 2-year mortality risk calculator for patients with carotid stenosis.
- To assess the feasibility and acceptability of CARAT in a clinical setting.
Main Methods:
- Modified existing clinical flowsheets within the electronic medical record for CARAT integration.
- Mapped existing clinical workflows and trained staff on CARAT utilization.
- Quantified CARAT usage and surveyed surgeons on its impact on decision-making.
Main Results:
- CARAT was successfully piloted within 6 months with minimal resources.
- The tool was utilized for 68% of eligible patients over 4 months.
- Most patients (98%) assessed had a low 2-year mortality risk, aligning with surgeon expectations.
Conclusions:
- CARAT successfully integrated into EMR, showing potential for evaluating mortality risk in carotid artery disease.
- Preliminary evidence suggests CARAT is a valuable tool for clinical decision-making.
- Further multi-center studies are needed to validate CARAT's risk calculation accuracy.
Background:
Patients with no history of stroke but with stenosis of the carotid arteries can reduce the risk of future stroke with surgery or stenting. At present, a physicians' ability to recommend optimal treatments based on an individual's risk profile requires estimating the likelihood that a patient will have a poor peri-operative outcomes and the likelihood that the patient will survive long enough to gain benefit from the procedure. We describe the development of the CArotid Risk Assessment Tool (CARAT) into a 2-year mortality risk calculator within the electronic medical record, integrating the tool into the clinical workflow, training the clinical team to use the tool, and assessing the feasibility and acceptability of the tool in one clinic setting.
Methods:
We modified an existing clinical flowsheet with the local electronic medical record for the CARAT risk model. To understand how CARAT would fit into the existing clinical workflow, we observed the clinic and talked with the clinical staff to develop a process map for the existing clinical workflow. CARAT was completed by the clinic nurse for patients identified on the clinic schedule as having carotid narrowing. We analyzed post-implementation assessment in two ways: quantifying the proportion of eligible patients with whom CARAT was utilized, and surveying surgeons to understand the impact of CARAT on decision-making and clinical workflow.
Results:
With minimum investment of institutional resources, we were able to produce a workable tool and pilot the tool in our clinic within a 6 month time period. Over 4 months, 287 patients were seen in the clinic with carotid narrowing, and clinic staff completed CARAT for 195 (68%). Per-surgeon completion rates ranged from 29 to 81%. Most patients (191 of 195, 98%) patients had a low 2-year calculated mortality risk. Most surgeons believed the risk assessment aligned with their expectations of patient predicted risk.
Conclusions:
We successfully integrated CARAT into the existing electronic medical record and have preliminary evidence that CARAT can be a valuable tool for evaluating mortality risk for patients with diseased carotid arteries. Accuracy of the risk calculations must be evaluated in larger, multi-center studies.
