Among CVRM patients , the results tended towards a beneficial effect of CDSS , but only LDL-c target attainment in diabetes patients reached statistical significance .
Prompting , integration into the electronical health record , patient empowerment , and medication support were related to more effective CVRM .
Conclusion We did not find a clear clinical benefit from CDSS in cardiovascular risk factor levels and target attainment .
Some features of CDSS seem more promising than others .
Clinical relevance of CDSS in CVRM might additionally be sought in the improvement of shared decision making and patient empowerment
Background Cardiovascular risk management ( CVRM ) is notoriously difficult because of multi-morbidity and the different phenotypes and severities of cardiovascular disease .
Computerized decision support systems ( CDSS ) enable the clinician to integrate the latest scientific evidence and patient information into tailored strategies .
The effect on cardiovascular risk factor management is yet to be confirmed .
Effects of documentation-based decision support on chronic disease management.
OBJECTIVE To evaluate whether a new documentation-based clinical decision support system ( CDSS ) is effective in addressing deficiencies in the care of patients with coronary artery disease ( CAD ) and diabetes mellitus ( DM ) . STUDY DESIGN Controlled trial r and omized by physician . METHODS We assigned primary care physicians ( PCPs ) in 10 ambulatory practice s to usual care or the CAD/DM Smart Form for 9 months . The primary outcome was the proportion of deficiencies in care that were addressed within 30 days after a patient visit . RESULTS The Smart Form was used for 5.6 % of eligible patients . In the intention-to-treat analysis , patients of intervention PCPs had a greater proportion of deficiencies addressed within 30 days of a visit compared with controls ( 11.4 % vs 10.1 % , adjusted and clustered odds ratio = 1.14 ; 95 % confidence interval , 1.02 - 1.28 ; P = .02 ) . Differences were more pronounced in the " on-treatment " analysis : 17.0 % of deficiencies were addressed after visits in which the Smart Form was used compared with 10.6 % of deficiencies after visits in which it was not used ( P < .001 ) . Measures that improved included documentation of smoking status and prescription of antiplatelet agents when appropriate . CONCLUSIONS Overall use of the CAD/DM Smart Form was low , and improvements in management were modest . When used , documentation-based decision support shows promise , and future studies should focus on refining such tools , integrating them into current electronic health record platforms , and promoting their use , perhaps through organizational changes to primary care practice
Among CVRM patients , the results tended towards a beneficial effect of CDSS , but only LDL-c target attainment in diabetes patients reached statistical significance .
Prompting , integration into the electronical health record , patient empowerment , and medication support were related to more effective CVRM .
Conclusion We did not find a clear clinical benefit from CDSS in cardiovascular risk factor levels and target attainment .
Some features of CDSS seem more promising than others .
Clinical relevance of CDSS in CVRM might additionally be sought in the improvement of shared decision making and patient empowerment
Background Cardiovascular risk management ( CVRM ) is notoriously difficult because of multi-morbidity and the different phenotypes and severities of cardiovascular disease .
Computerized decision support systems ( CDSS ) enable the clinician to integrate the latest scientific evidence and patient information into tailored strategies .
The effect on cardiovascular risk factor management is yet to be confirmed .