Use of a Web‐based clinical decision support system to improve abdominal aortic aneurysm screening in a primary care practice

Abstract

Rationale, aims and objectivesThe United States Preventive Services Task Force recommends a one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography for men aged 65 to 75 years who have ever smoked. However, despite a mortality rate of up to 80% for ruptured AAAs, providers order the screening for a minority of patients. We sought to determine the effect of a Web-based point-of-care clinical decision support system on AAA screening rates in a primary care practice.MethodsWe conducted a retrospective review of medical records of male patients aged 65 to 75 years who were seen at any of our practice sites in 2007 and 2008, before and after implementation of the clinical decision support system.ResultsOverall screening rates were 31.36% in 2007 and 44.09% in 2008 (P-value: <0.001). Of patients who had not had AAA screening prior to the visit, 3.22% completed the screening after the visit in 2007, compared with 18.24% in 2008 when the clinical support system was implemented, 5.36 times improvement (P-value: <0.001).ConclusionsA Web-based clinical decision support for primary care physicians significantly improved delivery of AAA screening of eligible patients. Carefully developed clinical decision support systems can optimize care delivery, ensuring that important preventive services are delivered to eligible patients.

A Robust e-Epidemiology Tool in Phenotyping Heart Failure with Differentiation for Preserved and Reduced Ejection Fraction: the Electronic Medical Records and Genomics (eMERGE) Network

“…This patient population is self-insured; thus, PCIM has developed strategies including case management of chronic illnesses and EMR clinical decision support [26] to assist primary care providers with preventative services. Mayo Clinic has standardized care process models [27] throughout Mayo Clinic for chronic diseases including both HF with preserved and reduced EF.…”

Abdominal aortic aneurysm screening in the United States

“…KP SoCal also reported that AAA screening was slowly implemented throughout all of their regional medical centers and clinics [18]. The authors of the Mayo Clinic Rochester study also cautioned that some physicians may reject new technology and software systems that would hinder effective delivery of AAA screening and management strategies for detected AAA [7]. This could negatively influence new patient enrollment for AAA screening among health systems using Medicare.…”

“…The intent of the SAVE and Dare to CARE programs was to raise cardiovascular health awareness for the older population. In 2008, the Mayo Clinic in Rochester, Minnesota, implemented a Web-based clinical decision support system and EMR to help improve their AAA screening programs among primary care clinics within the Rochester region [7]. Furthermore, there is recently a clinical trial evaluating screening for vascular diseases, including AAA disease, in the urban areas of the state of Illinois [16].…”

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