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 .
Typical Electronic Health Record Use in Primary Care Practices and the Quality of Diabetes Care
PURPOSE Recent efforts to encourage meaningful use of electronic health records ( EHRs ) assume that widespread adoption will improve the quality of ambulatory care , especially for complex clinical conditions such as diabetes . Cross-sectional studies of typical uses of commercially available ambulatory EHRs provide conflicting evidence for an association between EHR use and improved care , and effects of longer-term EHR use in community-based primary care setting s on the quality of care are not well understood . METHODS We analyzed data from 16 EHR-using and 26 non – EHR-using practice s in 2 northeastern states participating in a group-r and omized quality improvement trial . Measures of care were assessed for 798 patients with diabetes . We used hierarchical linear models to examine the relationship between EHR use and adherence to evidence -based diabetes care guidelines , and hierarchical logistic models to compare rates of improvement over 3 years . RESULTS EHR use was not associated with better adherence to care guidelines or a more rapid improvement in adherence . In fact , patients in practice s that did not use an EHR were more likely than those in practice s that used an EHR to meet all of 3 intermediate outcomes targets for hemoglobin A1c , low-density lipoprotein cholesterol , and blood pressure at the 2-year follow-up ( odds ratio = 1.67 ; 95 % CI , 1.12–2.51 ) . Although the quality of care improved across all practice s , rates of improvement did not differ between the 2 groups . CONCLUSIONS Consistent use of an EHR over 3 years does not ensure successful use for improving the quality of diabetes care . Ongoing efforts to encourage adoption and meaningful use of EHRs in primary care should focus on ensuring that use succeeds in improving care . These efforts will need to include provision of assistance to longer-term EHR users
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 .