Ehr-Embedded Decision Support To Prevent Stroke In Patients With Af
Posted Date: Apr 1, 2020
- Investigator: Mark Eckman
- Specialties: Cardiology, Cardiovascular Disease, Heart Disease, Neurology
- Type of Study: Observational/Survey
Background and Significance - Atrial fibrillation (AF) is the most common significant cardiac rhythm disorder and is a powerful common risk factor for stroke. Randomized trials have demonstrated that anticoagulation can reduce the risk of stroke in patients with AF. Yet, there continues to be widespread underutilization of this therapy. From our last review of AF patients in the UC Health system, we estimate that up to 1,927 AF patients are not receiving optimal treatment to prevent stroke. Objectives - The objective of this project, “EHR-Embedded Decision Support to Prevent Stroke in Patients with AF”, is to improve thromboprophylaxis treatment decisions for patients with non-valvular AF and to increase awareness of the underutilization of appropriate thromboprophylaxis in our University of Cincinnati Health system, including vulnerable populations with health disparities. To achieve this objective, we will implement and evaluate the effectiveness of an Atrial Fibrillation Decision Support Tool (AFDST), embedded within our electronic health record (EHR) that will: (a) identify at the point of care, patients who might benefit substantially from a change in their current thromboprophylaxis; (b) provide patient-tailored guidance to support decision-making; and (c) provide an opportunity to refer the patient to a pharmacist-staffed AF Thromboprophylaxis Shared Decision-Making consultation service. Provide a brief explanation of how the idea will work, including the target audience, Please include the lead-time for implementation and brief explanation of what needs to be accomplished if/once approved. Please address: who, what, where, when. Please summarize incremental resources anticipated to be added with this idea. Please include alternatives considered and why such alternatives were not proposed. Please identify any barriers to adoption/implementation and any implications if not implemented/approved. Aim for 1-2 paragraphs. Approach: We will achieve our study goals by performing a randomized controlled trial that examines two strategies – 1) AFDST without BPA (current state), or 2) AFDST with BPA and semi-automated order set to refer patients to an AF Thromboprophylaxis Shared Decision-Making Service. Roughly 144 clinicians in the UC Health Primary Care Network and Hoxworth-based GIM ambulatory practices will be involved in this study. Their patients will be randomized into either of the two study arms described above. Patients will enter the study as their clinicians receive BPAs, or in the case of the control arm, when BPAs would have been generated as clinicians open medical records of patients for whom current thromboprophylaxis is not optimal. A recent data pull from our EHR identified roughly 4,700 active patients fitting our inclusion and exclusion criteria in our UC Health system. Based on earlier studies, in our UC Health AF cohort, 41% of patients were receiving “non-optimal” thromboprophylaxis (1,927), and 49% of those (944) could gain 0.5 QALYs or more if they were to receive “optimal therapy.” Conservatively, we estimate enrollment of 800 patients (400 in each of 2 study arms) during the 18-month planned enrollment period.
Patients Will Be Included If They Have A Diagnosis Of Atrial Fibrillation Or Atrial Flutter And Their Primary Care Physician Has Consented To Participate. Patients With Valvular Heart Disease Or Prosthetic Heart Valves Will Be Excluded. For The Second Aim Of The Study, Patients Must Also Be Fluent In English And Be At Least 18 Years Of Age.
Atrial Fibrillation, Anticoagulation Therapy, Decision Support
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