An Informatics Approach to Implement Support for Shared Decision Making for Primary Prevention Statin Therapy

Area of Science:

• Informatics
• Health Services Research
• Cardiology

Background:

• Shared decision making (SDM) is recommended for initiating statin therapy for primary prevention but is underutilized.
• An informatics decision-support tool was developed to integrate the Mayo Clinic Statin Choice decision aid into electronic health records (EHRs) at the point-of-care.

Purpose of the Study:

• To evaluate the impact of an EHR-embedded decision-support tool on the utilization of shared decision making (SDM) for primary prevention statin therapy.
• To assess changes in primary care providers' attitudes, perceived competence, and usage of SDM and decision aids.

Main Methods:

• An iterative approach was used to design and implement a single-click EHR tool for automated atherosclerotic cardiovascular disease (ASCVD) risk calculation and Statin Choice decision aid population.
• Pre- and post-intervention surveys assessed primary care providers' attitudes, competence, and usage of SDM for statin initiation.
• Web traffic to the Statin Choice website was analyzed before and after the intervention.

Main Results:

• Post-intervention, providers showed increased awareness of the Statin Choice decision aid (P < 0.001) and reported higher competence in SDM (P = 0.047).
• Usage of decision aids for statin initiation increased significantly (P = 0.043), with a rise in Statin Choice website usage from 3.4 to 5.2 per 1,000 outpatient visits (P = 0.002).
• No significant changes were observed in physician attitudes toward SDM.

Conclusions:

• Implementing a point-of-care decision-support tool effectively increased the utilization of decision aids for primary prevention statin therapy.
• The observed increase in decision aid usage was not mediated by changes in physician attitudes towards SDM.