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Physicians Voluntarily Using an EHR-Based CDS Tool Improved Patients' Guideline-Related Statin Prescription Rates: A
Timothy S Chang1, Ashwin Buchipudi2, Gregg C Fonarow3
1Department of Neurology, University of California, Los Angeles, Los Angeles, California, United States.
Insights
A clinical decision support (CDS) tool, the statin macro, increased statin prescription rates for eligible patients. This tool, despite low usage, improved adherence to 2013 American College of Cardiology/American Heart Association (ACC/AHA) statin guidelines.
Area of Science:
- Cardiology
- Health Informatics
- Clinical Practice Guidelines
Background:
- The 2013 ACC/AHA guideline for statin therapy initiation introduced a complex 10-year risk calculation, making manual assessment difficult.
- Suboptimal compliance with statin guidelines has been observed, with many eligible patients not receiving prescribed statin therapy.
- Clinical decision support (CDS) tools show potential for improving adherence to statin guidelines, but few have been evaluated for clinical outcomes.
Purpose of the Study:
- To determine if the use of a specific CDS tool, the 'statin macro,' was associated with improved compliance with the 2013 ACC/AHA statin guideline.
- The study focused on statin prescription versus no statin prescription, not on the intensity of statin therapy recommended by the guidelines.
Main Methods:
- A clinician-initiated, EHR-embedded 'statin macro' was developed to display ACC/AHA 2013 guideline recommendations.
- The study included 11,877 primary care patients eligible for statin therapy but not previously prescribed it, between January 1 and June 30, 2016.
- Relative risk and mixed-effects logistic regression were used to analyze the association between statin macro usage and statin prescription.
Main Results:
- The statin macro was used by 125 clinicians for 389 out of 11,877 eligible patients (3.2%).
- Statin prescription rates were higher when the statin macro was used (28%) compared to when it was not used (13%).
- Statin macro usage significantly increased the likelihood of statin prescription (odds ratio 2.86, p < 0.001), controlling for covariates.
Conclusions:
- Despite low adoption rates, the statin macro demonstrated a significant positive association with increased statin prescriptions for guideline-eligible patients.
- The findings suggest that CDS tools like the statin macro can be effective in improving adherence to cardiovascular prevention guidelines.
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 < 0.001). Controlling for patient covariates and clinicians, statin macro usage was significantly associated with statin therapy prescription (odds ratio 2.86, p < 0.001).
Conclusion:
Although the statin macro had low uptake, its use was associated with a greater rate of statin prescriptions (dosage not determined) for patients whom 2013 ACC/AHA guidelines required statin therapy.