Abstract:
< 3% of Americans have ideal cardiovascular health (CVH). The primary care encounter provides a setting in which to conduct patient-provider discussions of CVH. We implemented a CVH risk assessment, visualization, and decision-making tool that automatically populates with electronic health record (EHR) data during the encounter in order to encourage patient-centered CVH discussions among at-risk, yet under-treated, populations. We quantified five of the seven CVH behaviors and factors that were available in The Ohio State University Wexner Medical Center's EHR at baseline (May–July 2013) and compared values to those ascertained at one-year (May–July 2014) among intervention (n = 109) and control (n = 42) patients. The CVH of women in the intervention clinic improved relative to the metrics of body mass index (16% to 21% ideal) and diabetes (62% to 68% ideal), but not for smoking, total cholesterol, or blood pressure. Meanwhile, the CVH of women in the control clinic either held constant or worsened slightly as measured using those same metrics. Providers need easy-to-use tools at the point-of-care to help patients improve CVH. We demonstrated that the EHR could deliver such a tool using an existing American Heart Association framework, and we noted small improvements in CVH in our patient population. Future work is needed to assess how to best harness the potential of such tools in order to have the greatest impact on the CVH of a larger patient population.
Keywords
Prevention; Primary care; Medical informatics; Health outcomes; Disease management
Citation: Randi E. Foraker, Abigail B. Shoben, Marjorie M. Kelley, Albert M. Lai, Marcelo A. Lopetegui, Rebecca D. Jacksonb, Michael A. Langan, Philip R.O. Payne Electronic Health Record-based Assessment Of Cardiovascular Health: The Stroke Prevention In Healthcare Delivery Environments (Sphere) Study http://dx.doi.org/10.1016/j.pmedr.2016.07.006.
Received: 1 April 2016, Revised: 21 June 2016, Accepted: 8 July 2016, Available online: 13 July 2016
Copyright: © 2016 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Conclusions
This is the first study to develop and implement an EHR-based CVH visualization tool. Our study demonstrates that it is feasible to implement patient-centered EHR-based tools at the point-of-care in the primary care setting. Our work answers the call for next-generation EHR design to facilitate patient-provider communication (Street et al., 2014). The SPHERE study is a unique multidisciplinary collaboration aimed at addressing the feasibility of using a system embedded in the EHR to improve patient-centered care. Future work is needed to assess how to best harness the potential of such tools in order to have the greatest impact on the CVH of a patient population.
Declaration of competing interests
The authors declare that there are no conflicts of interest.
Funding sources
This study was funded by Pfizer Inc. (46214).
Acknowledgments
None.
