Computerized decision support for CVD risk did not improve outcomes

January 01, 0001

Computerized decision support for CVD risk did not improve outcomes

Computerized decision support systems (CDSSs) linked with electronic medical records (EMRs) are promoted as an effective means of improving patient care. These Canadian authors conducted a randomized controlled trial among EMR-using primary care practices in Ontario, Canada. Patients 55 years or older with previous vascular events, diabetes mellitus, hypertension, or hypercholesterolemia were randomized to the Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness (COMPETE III) CDSS intervention or to usual care. The intervention included personally tailored electronic vascular risk monitoring and treatment advice shared between the physician and patient, risk calculation, and a clinical resource. The primary outcome was a composite score of 8 recommended process outcomes at 1 year.

They found: "We randomized and included in the analysis 1102 patients in 49 community-based physician practices (53.4% female; mean age, 69.1 years; 28.0% with a previous vascular event). The intervention group (545 {49.5%}) had a significantly greater improvement in mean process composite, with a difference of 4.70 on a 27-point scale. Intervention patients had significantly higher odds of rating their continuity of care (4.18) and their ability to improve their vascular health (3.07) as improved. Despite this improvement, the clinical outcomes—vascular events, clinical variables, and quality of life—were not improved."

The authors concluded: "Despite favorable reviews and important improvements in the complex processes required to reduce vascular risk, clinical outcomes remain unchanged."

Caution with spending too much on such interventions that have not yet proven their benefits.

For the full abstract, click here.

Arch Intern Med 171(19):1736-1744, 24 October 2011 © 2011 to the American Medical Association
Shared Electronic Vascular Risk Decision Support in Primary Care - Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness (COMPETE III) Randomized Trial. Anne Holbrook, Eleanor Pullenayegum, Lehana Thabane, et al. Correspondence to Dr. Holbrook: holbrook@mcmaster.ca

Category: HSR. Health Services Research, K. Circulatory. Keywords: computerized decision support, electronic medical records, cardiovascular risk, vascular events, quality of life, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 4 November 2011

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