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BACKGROUND/RATIONALE:
Despite the existence of evidence-based guidelines, there is a gap between evidence-based recommended best medical practice and actual practice. In previous work, we have used hypertension as a model to study the translation of research clinical targets and drug choice into primary care practice through computer-based implementation of clinical practice guidelines. In collaboration with experts in guideline-automation at Stanford Medical Informatics (SMI), we developed an innovative clinical decision support system: ATHENA-HTN (hypertension). We have demonstrated that deploying this sophisticated system in VA primary care clinics is feasible and clinicians find the system usable and useful, as shown by their actual extensive use of the system and their response to questionnaire survey. We have also found that the system improved clinician prescribing.
OBJECTIVE(S):
Our objectives in this QUERI-funded VISN Implementation Collaborative include: (1) implement evidence-based guidelines for hypertension by upgrading the ATHENA knowledge-base (KB) to the most recent guidelines; (2) deploy the system in 5 medical centers within VISN 1 to generate individualized recommendations to primary care clinicians caring for patients in outpatient clinics; (3) evaluate the implementation.
METHODS:
In Phase 1 we planed to update the KB and conduct offline testing; to revise the M program that extracts patient data daily from VistA to extract additional data elements; to streamline the system architecture to make it easier to implement in multiple sites; to work with the site-PIs to obtain IRB approval at 5 implementation sites in VISN 1 plus the coordinating site at VA Palo Alto; to improve the user interface design; to identify and resolve issues in implementing new information technology in multiple different VAMCs with different CPRS implementations; to train the site PIs in use of the system; to work with representatives of VA Office of Information to strategize approaches to write-back of data to VistA; and perform baseline data analysis to inform the randomization. In Phase 2 we plan to recruit primary care providers from the participating 5 medical centers in VISN 1; randomize clinics to ATHENA-HTN intervention or usual care; deploy the system for intervention providers; train intervention providers in use of the system; and conduct a 12-month clinical trial of the system. In Phase 3 we plan to analyze the results of the clinical trial.
FINDINGS/RESULTS:
Project is ongoing.
IMPACT:
Our VISN Collaborative study will provide insight into how to upgrade automated guidelines (an important issue in light of rapid changes in clinical knowledge and guidelines) and how to integrate the system with the VA electronic medical record across multiple VAMCs. We will learn about barriers and facilitators for clinician guideline adherence, and the impact of this quality improvement strategy on clinician prescribing and patient blood pressures, to learn how clinical decision support systems can best be implemented to assist clinicians in providing evidence-based care for patients
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Communication and Decision Making, Quality of Care
Keywords:
Decision support, Diabetes, Hypertension
MeSH Terms:
none
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