We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Effect of clinical decision support for severe hypercholesterolemia on low-density lipoprotein cholesterol levels.
- Authors
Bangash, Hana; Saadatagah, Seyedmohammad; Naderian, Mohammadreza; Hamed, Marwan E.; Alhalabi, Lubna; Sherafati, Alborz; Sutton, Joseph; Elsekaily, Omar; Mir, Ali; Gundelach, Justin H.; Gibbons, Daniel; Johnsen, Paul; Wood-Wentz, Christina M.; Smith, Carin Y.; Caraballo, Pedro J.; Bailey, Kent R.; Kullo, Iftikhar J.
- Abstract
Severe hypercholesterolemia/possible familial hypercholesterolemia (FH) is relatively common but underdiagnosed and undertreated. We investigated whether implementing clinical decision support (CDS) was associated with lower low-density lipoprotein cholesterol (LDL-C) in patients with severe hypercholesterolemia/possible FH (LDL-C ≥ 190 mg/dL). As part of a pre-post implementation study, a CDS alert was deployed in the electronic health record (EHR) in a large health system comprising 3 main sites, 16 hospitals and 53 clinics. Data were collected for 3 months before ('silent mode') and after ('active mode') its implementation. Clinicians were only able to view the alert in the EHR during active mode. We matched individuals 1:1 in both modes, based on age, sex, and baseline lipid lowering therapy (LLT). The primary outcome was difference in LDL-C between the two groups and the secondary outcome was initiation/intensification of LLT after alert trigger. We identified 800 matched patients in each mode (mean ± SD age 56.1 ± 11.8 y vs. 55.9 ± 11.8 y; 36.0% male in both groups; mean ± SD initial LDL-C 211.3 ± 27.4 mg/dL vs. 209.8 ± 23.9 mg/dL; 11.2% on LLT at baseline in each group). LDL-C levels were 6.6 mg/dL lower (95% CI, −10.7 to −2.5; P = 0.002) in active vs. silent mode. The odds of high-intensity statin use (OR, 1.78; 95% CI, 1.41–2.23; P < 0.001) and LLT initiation/intensification (OR, 1.30, 95% CI, 1.06–1.58, P = 0.01) were higher in active vs. silent mode. Implementation of a CDS was associated with lowering of LDL-C levels in patients with severe hypercholesterolemia/possible FH, likely due to higher rates of clinician led LLT initiation/intensification.
- Subjects
UNITED States; ANTILIPEMIC agents; HUMAN services programs; BLOOD testing; RESEARCH funding; CLINICAL decision support systems; MEDICAL care; EVALUATION of human services programs; FISHER exact test; MULTIPLE regression analysis; FAMILIAL hypercholesterolemia; SEVERITY of illness index; LDL cholesterol; TREATMENT effectiveness; TREATMENT duration; CHI-squared test; MANN Whitney U Test; PRE-tests &; post-tests; ODDS ratio; ELECTRONIC health records; RESEARCH; HOSPITAL health promotion programs; CENTERS for Disease Control &; Prevention (U.S.); CONFIDENCE intervals; MEDICAL screening; QUALITY assurance; DATA analysis software; EVALUATION
- Publication
NPJ Digital Medicine, 2024, Vol 7, Issue 1, p1
- ISSN
2398-6352
- Publication type
Article
- DOI
10.1038/s41746-024-01069-w