Reducing Cardiovascular Risk in Adults With Serious Mental Illness
Condition: Chronic Disease; Mental Disorder; Health Behavior; Bipolar Disorder; Schizophrenia
MeSH terms: Chronic Disease; Schizophrenia; Bipolar Disorder; Mental Disorders
Study type: Interventional

Summary: 
      This purpose of this study is to adapt, implement and test the ability of a sophisticated
      point-of-care electronic health record-based clinical decision support that identifies and
      prioritizes all available evidence-based treatment options to reduce cardiovascular risk in
      patients with serious mental illness.
    

Detailed description: 
      This study adapted a point-of-care electronic health record-based clinical decision support
      system (The Cardiovascular Wizard) to help primary care providers identify, provide
      appropriate care for, and control cardiovascular risk factors for patients with serious
      mental illness (bipolar disorder, schizophrenia, schizo-affective disorder). The
      Cardiovascular Wizard is designed to educate primary care providers about the increased risk
      of cardiovascular disease and mortality in people with serious mental illness, identify
      elevated cardiovascular risk factors in patients with serious mental illness, identify
      elevated cardiovascular risk factors in patients with serious mental illness, prioritize
      these cardiovascular risk based on how much improvement in cardiovascular risk a patient
      would experience if the cardiovascular risk factor was adequately addressed, recommend
      specific medications and other interventions to decrease each elevated cardiovascular risk
      factor, and provide this information in an easy-to-understand format for both patients with
      serious mental illness and their primary care providers.

      The Cardiovascular Wizard was printed in intervention clinics and (i) compiled lab data (most
      recent glycated hemoglobin, systolic blood pressure and low-density lipoprotein levels), body
      mass index, smoking status, and aspirin use, (ii) calculated a modifiable 10 year
      cardiovascular risk for stroke or heart attack using the American College of
      Cardiology/American Heart Association 10-year atherosclerotic cardiovascular disease risk
      equation, (iii) prioritized clinical domains based on the absolute risk reduction for each
      component, (iv) compiled information related to liver and renal function, creatinine kinase
      level, and previous diagnoses (Congestive Heart Failure, Cardiovascular Disease, Diabetes
      Mellitus, and (v) provided recommendations for intensification of therapy for glycated
      hemoglobin, systolic blood pressure, and/or low-density lipoproteins if not at goal.
      Recommendations were based on evidence-based protocols including Joint National Committee,
      American Diabetes Association, and the Institute for Clinical Systems Improvement.
    

Intervention name(s): Prioritized Clinical Decision Support
Intervention type(s): Behavioral
Intervention description(s): After entry of blood pressure data at all primary care visits, relevant electronic health record data were automatically extracted, encrypted and processed through Web-based clinical algorithms that determined if the patient met intervention eligibility criteria. In intervention clinics, the rooming staff received a best practice alert and printed patient and primary care provider versions of the clinical decision support that identified evidence-based treatment options for any uncontrolled cardiovascular risk factors and prioritized treatment recommendations based on potential cardiovascular risk reduction. Cardiovascular risk factors addressed in study participants were control of lipids, blood pressure, weight, tobacco, glucose and appropriate aspirin use. In control clinics, rooming staff did not receive a best practice alert and patients and primary care providers did not receive and were not able to access the clinical decision support.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Clinics have been randomized into a treatment and a control arm.
Masking: None (Open Label)
Primary purpose: Treatment