Clinical trial NCT02742545: Impact of MayoExpertAdvisor on Provider Adherence
Official title: Impact of MayoExpertAdvisor (MEA) on Provider Adherence to Guideline Recommended Treatment for Hyperlipidemia, Atrial Fibrillation, and Heart Failure
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Hyperlipidemia
Atrial Fibrillation
Heart Failure
Lead sponsor: Mayo Clinic
Sponsor class: OTHER
First posted: 2016-04-19
Enrollment: 2248
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This study evaluates the efficacy of MayoExpertAdvisor (MEA), a knowledge delivery tool, to improve adherence to best practices for patients with hyperlipidemia, atrial fibrillation and heart failure. Half of the clinicians will receive MEA, while the other half will not receive MEA.

The investigators hypothesize care teams with access to MEA will act upon recommendations at a higher rate than those care teams in the standard of care arm without access to MEA.

Detailed description: MEA is designed to increase adherence to consensus national guidelines and quality measures which are the standard of care for hyperlipidemia, atrial fibrillation, and heart failure. These diseases were selected based on national data which suggest there is less than optimal adherence to standard of care therapy and this non-adherence is associated with adverse cardiovascular outcomes.

There are 29 care teams in the Employee and Community Health (ECH) practice. Care teams are comprised of 4-8 clinicians who provide primary care to between 3,000 and 8000 patients. 8 care teams are resident/fellow led and will be excluded from the study. The remaining 21 care teams in the ECH practice will be stratified by clinic location and provider specialty (Internal Medicine, Family Medicine). 20 care teams will then be cluster-randomized to either the intervention arm or standard of care arm.

Prior to randomization, clinicians in both arms will receive the same educational module to the current guidelines for management of the atrial fibrillation, heart failure and hyperlipidemia. Clinicians in the intervention arm will receive training by the research team on the use of MEA. This training will clearly inform clinicians that they are always to use their best clinical judgment.

Eligibility criteria: Clinician Inclusion Criteria:

* Physicians
* Assistants
* Nurse Practitioners

Clinician Exclusion Criteria:

* Clinicians providing care to nursing home patients
* Pediatricians
* Residents and fellows

Patient Record Inclusion Criteria:

* Diagnosis of hyperlipidemia, atrial fibrillation, and/or heart failure

Patient Record Exclusion Criteria:

* Unscheduled visits

Primary outcomes:
measure: Percentage of pre-visit recommendations for hyperlipidemia acted upon by providers
timeFrame: Baseline to 6 months
measure: Percentage of pre-visit recommendations for atrial fibrillation acted upon by providers
timeFrame: Baseline to 6 months
measure: Percentage of pre-visit recommendations for heart failure acted upon by providers
timeFrame: Baseline to 6 months
Secondary outcomes:
Other outcomes:
Locations:
city: Rochester
country: United States
facility: Mayo Clinic in Rochester
state: Minnesota
Study officials:
affiliation: Mayo Clinic
name: Paul M McKie, M.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: McKie PM, Kor DJ, Cook DA, Kessler ME, Carter RE, Wilson PM, Pencille LJ, Hickey BC, Chaudhry R. Computerized Advisory Decision Support for Cardiovascular Diseases in Primary Care: A Cluster Randomized Trial. Am J Med. 2020 Jun;133(6):750-756.e2. doi: 10.1016/j.amjmed.2019.10.039. Epub 2019 Dec 18.
citation: Kessler ME, Carter RE, Cook DA, Kor DJ, McKie PM, Pencille LJ, Scheitel MR, Chaudhry R. Impact of electronic clinical decision support on adherence to guideline-recommended treatment for hyperlipidaemia, atrial fibrillation and heart failure: protocol for a cluster randomised trial. BMJ Open. 2017 Dec 4;7(12):e019087. doi: 10.1136/bmjopen-2017-019087.