Effect of clinical decision support for severe hypercholesterolemia on low-density lipoprotein cholesterol levels.

Autor:	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.
Předmět:	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 CONFIDENCE intervals MEDICAL screening QUALITY assurance DATA analysis software EVALUATION
Zdroj:	NPJ Digital Medicine; 3/18/2024, Vol. 7 Issue 1, p1-9, 9p
Abstrakt:	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. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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