bs_bs_baner Effect of visit length and a clinical decision support tool on abdominal aortic aneurysm screening rates in a primary care practicejep_1625 593.598 John Eaton MD,1 Darcy Reed MD MPH,2 Kurt B. Angstman MD,3 Kris Thomas MD,2 Frederick North MD,2 Robert Stroebel MD,2 Sidna M. Tulledge-Scheitel MD MPH4 and Rajeev Chaudhry MBBS MPH5 1Internal Medicine Resident, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA 2Assistant Professor of Medicine, Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA 3Assistant Professor of Family Medicine, Department of Family Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA 4Assistant Professor of Medicine, Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA and Assistant Professor of Medicine, Global Products and Services, Mayo Clinic Rochester, Rochester, MN, USA 5Assistant Professor of Medicine, Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA and Assistant Professor of Medicine, Center for Innovation, Mayo Clinic College of Medicine, Rochester, MN, USA Journal of Evaluation in Clinical Practice ISSN 1365-2753 Keywords abdominal aortic aneurysm, clinical decision support systems, delivery of health care, patient care team, patient-centred care, preventive services Correspondence Dr Rajeev Chaudhry Division of Primary Care Internal Medicine Center for Innovation Department of Internal Medicine Mayo Clinic College of Medicine 200 First St. S.W. Rochester MN 55905 USA E-mail: chaudhry.rajeev@mayo.edu Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/ onlineopen#OnlineOpen_Terms Accepted for publication: 12 November 2010 doi:10.1111/j.1365-2753.2010.01625.x Abstract Rationale, aims and objectives In 2005, the US Preventive Services Task Force issued recommendations for one-time abdominal aortic aneurysm (AAA) screening using abdominal ultrasonography in men aged 65 to 75 years with a history of smoking. However, despite a mortality rate of up to 80% for ruptured AAAs, providers order the screening for a minority of patients. We examined AAA screening rates among providers and investigated the role of visit duration and other factors in whether patients received screening. We also looked for potential interventions to improve compliance. Methods We retrospectively reviewed the records of patients who visited our clinic over a 4-month period and met the US Preventive Services Task Force criteria for AAA screening when our practice had a real-time decision support tool implemented to identify patients due for the screening. We also surveyed our clinic’s providers about their knowledge and attitudes regarding AAA screening. Results Despite the use of physician reminders, providers ordered screening for only 12.9% of eligible patients. Screening was more likely to be ordered during longer visits versus shorter ones (24% vs. 6%). When surveyed, most providers (70.6%) indicated that a nurse-directed ordering system would improve compliance. Conclusions This study illustrates that physician reminders alone are not sufﬁcient to improve care and that more time is needed for preventive services. This provides additional support for the use of a multidisciplinary approach to preventive screening, as in a patient- centred medical home. In a patient-centred medical home, a care team of physicians, nurses and ofﬁce staff use technology such as clinical decision support to provide comprehensive, coordinated patient care. Competing interests: The authors declare that they have no competing interests relevant to this article. Author contributions: JE carried out the data and statistical analysis (with assistance from the Center for Translational Science Activities), assisted in study design, and drafted the manuscript. DR, KBA, KT participated in the study design and data analysis and helped draft the manuscript. FN, RS, SMT-S participated in the design of the study and provided critical revisions of intellectual content. RC conceived the study, participated in its design and coordination, helped draft the manuscript, and gave ﬁnal approval. List of abbreviations: AAA, abdominal aortic aneurysm; USPSTF, US Preventive Services Task Force; HIT, health information technology. © 2011 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 18 (2012) 593–598 593