Weill Medical College of Cornell University
The goal of this study is to improve how primary care providers identify and manage patients at risk for heart disease. One tool that can help with this is a coronary artery calcium (CAC) test, which looks for calcium buildup in the heart's arteries and can help estimate a person's risk of future heart problems. The main questions this study aims to answer are: Will a new electronic health record (EHR) alert that provides guidance on when to consider a CAC test be feasible and acceptable to primary care providers? Does the alert change how often providers order CAC tests, start or change the dose of cholesterol-lowering medications, and refer patients to cardiology? In this study, a new EHR alert will be implemented as part of routine clinical practice for primary care providers at Weill Cornell Internal Medicine Associates (WCIMA). The alert will provide guidance on considering a CAC test, cholesterol-lowering medication, or referral to cardiology for eligible patients. Researchers will compare clinical care before and after the alert is implemented. They will look at how often CAC tests are ordered and completed, how often cholesterol-lowering medications are started or their doses are changed, and how often patients are referred to cardiology. After the implementation period, primary care providers will also be asked to complete a brief survey and participate in an interview about the alert.
Researchers will conduct an implementation pilot using a pre- and post-implementation design to evaluate the impact of an electronic health record (EHR)-based Practice Advisory (OPA) on clinical and implementation outcomes. The study will take place at Weill Cornell Internal Medicine Associates (WCIMA), a large academic, hospital-based primary care practice at Weill Cornell Medicine and NewYork-Presbyterian Hospital in New York, NY. The study will include EHR data from adults without known cardiovascular disease (CVD) who have borderline to intermediate PREVENT-estimated 10-year ASCVD risk and…
Inclusion Criteria: \- Primary care provider (physician or nurse practitioner) at Weill Cornell Internal Medicine Associates (WCIMA). Exclusion Criteria: \- Not a primary care provider (physician or nurse practitioner) at WCIMA.
This OPA, which will be within the EHR, will be visible when a patient has borderline or intermediate PREVENT-estimated 10-year ASCVD risk and lipid-lowering treatment decisions remain uncertain. The proposed actions will be: Discuss the patient's cholesterol and elevated cardiovascular risk. Guide the clinician on ordering a CAC test. Consider referral to a cardiologist or subspecialist. Consider initiation or dose titration of lipid-lowering therapy. The goal is to understand the impact of the OPA on primary care clinicians' clinical decision-making surrounding patients with borderline or intermediate ASCVD risk.