Sequist:Can Risk Score Alerts Improve Office Care for Chest Pain?

Brigham And Women'S Hospital, Boston MA

Investigators

Linked publications & trials

Abstract

The evaluation of ambulatory patients with chest pain is a challenging and serious[unreadable] problem, accounting for a significant proportion of all outpatient visits. High risk patients may go[unreadable] undetected, resulting in missed diagnoses of acute myocardial ischemia, while low risk patients[unreadable] may be subject to unnecessary evaluations. To substantially improve the evaluation and[unreadable] treatment of outpatients with acute chest pain syndromes, new strategies need to be developed[unreadable] in the primary care setting to risk stratify symptomatic patients and direct appropriate care.[unreadable] This study will implement and evaluate electronic risk alerts to risk stratify outpatients[unreadable] with chest pain and present this information to primary care clinicians within the context of an[unreadable] electronic health record. The intervention will take place within Harvard Vanguard Medical[unreadable] Associates, a multispecialty integrated group practice with 140 primary care physicians caring[unreadable] for approximately 300,000 patients at 14 centers in eastern Massachusetts. With a randomized,[unreadable] controlled study design, the study has three specific aims:[unreadable] 1) To identify predictors of risk-appropriate evaluation and treatment of patients presenting to[unreadable] primary care offices with acute chest pain, including race and sex.[unreadable] 2) To determine whether rates of appropriate evaluation and treatment of patients with acute[unreadable] chest pain can be improved through the use of point-of-care electronic risk alerts that[unreadable] provide individual patient cardiac risk profiles and tailored evaluation and treatment[unreadable] recommendations to primary care clinicians.[unreadable] 3) To perform a cost analysis for the provision of electronic decision support for patients with[unreadable] acute chest pain.[unreadable] This study has important implications for determining how the treatment of outpatients[unreadable] with chest pain syndromes can be optimized through the innovative use of electronic decision[unreadable] support, while documenting the cost implications of such a strategy. This work will also provide[unreadable] a model for how ambulatory practices across the country can use electronic health records to[unreadable] present real-time patient risk information to clinicians with the goal of improving patient safety[unreadable] and quality, which has important implications for both acute and chronic care.