Use of a Web‐based clinical decision support system to improve abdominal aortic aneurysm screening in a primary care practice

Rajeev Chaudhry,Doug A Parks,Lindsay K Decker,Sidna M Tulledge‐Scheitel,Robert J Stroebel,Kurt B Angstman

doi:10.1111/j.1365-2753.2011.01661.x

Rajeev Chaudhry, Doug A Parks + Show 4 more

Open Access

https://doi.org/10.1111/j.1365-2753.2011.01661.x

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Abstract

Rationale, aims and objectivesThe United States Preventive Services Task Force recommends a one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography for men aged 65 to 75 years who have ever smoked. However, despite a mortality rate of up to 80% for ruptured AAAs, providers order the screening for a minority of patients. We sought to determine the effect of a Web-based point-of-care clinical decision support system on AAA screening rates in a primary care practice.MethodsWe conducted a retrospective review of medical records of male patients aged 65 to 75 years who were seen at any of our practice sites in 2007 and 2008, before and after implementation of the clinical decision support system.ResultsOverall screening rates were 31.36% in 2007 and 44.09% in 2008 (P-value: <0.001). Of patients who had not had AAA screening prior to the visit, 3.22% completed the screening after the visit in 2007, compared with 18.24% in 2008 when the clinical support system was implemented, 5.36 times improvement (P-value: <0.001).ConclusionsA Web-based clinical decision support for primary care physicians significantly improved delivery of AAA screening of eligible patients. Carefully developed clinical decision support systems can optimize care delivery, ensuring that important preventive services are delivered to eligible patients.

Highlights

The prevalence of abdominal aortic aneurysm (AAA), a ballooning of a segment of a weak aortic arterial wall in the abdomen, is estimated to be 4% to 9% in men and 1% in women [1,2,3,4,5,6,7]
The United States Preventive Services Task Force recommends a onetime screening for men aged 65 to 75 years who have ever smoked [13,14]
We retrospectively examine the impact of a Web-based clinical decision support system in improving the AAA screening rate for eligible patients seen in our primary care clinics

Summary

Introduction

The prevalence of abdominal aortic aneurysm (AAA), a ballooning of a segment of a weak aortic arterial wall in the abdomen, is estimated to be 4% to 9% in men and 1% in women [1,2,3,4,5,6,7]. The prevalence of an AAA greater than 5.0 cm in men aged 50 to 79 years is estimated to be 0.5% [8]. AAA is the 14th leading cause of death in the USA, with as many as 9000 deaths occuring annually as a result of rupture of a 5-cm aneurysm [10,11]. The United States Preventive Services Task Force recommends a onetime screening for men aged 65 to 75 years who have ever smoked [13,14]

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