Coronary artery disease (CAD) is the leading cause of death in the United States, and guidelines for the prevention of CAD are well established and of proven benefit. Nevertheless, there remains a wide gap between these guidelines and actual clinical practice. The long-term objective of Dr. Schnipper, an Instructor at Harvard Medical School, is to improve the provision of cardiac preventive services. Dr. Schnipper spent most of his fellowship in general internal medicine studying the patient, physician, and system factors that lead to sub-optimal cardiac preventive care. He joined the faculty of the General Medicine Division at Brigham and Women's Hospital because of their experience developing and testing information systems to improve quality of clinical care and to work with his mentor, Dr. David Bates. This research project has four specific aims: 1) To develop a decision support tool, integrated into an electronic medical record (EMR), designed to improve the primary and secondary prevention of coronary artery disease. 2) To develop an EMR-based case management system to improve the secondary prevention of CAD. 3) To determine the effectiveness and cost-effectiveness of EMR-based clinical decision support and case management on the implementation of cardiac preventive services. 4) To identify and address patient, clinician, and system barriers to the effective use of computer-based quality improvement strategies in a variety of outpatient practice settings. The early phases of this project will consist of physician focus groups, questionnaires, and iterative development and testing of these interventions. Later, a series of three controlled trials, randomized by practice site, will compare usual care to decision support and decision support plus case management. Dr. Schnipper will be aided in this endeavor by an advisory committee of senior faculty with varied expertise. This research will lead to better ways to implement cardiac prevention. The experience gained by conducting this research, coupled with additional course work and mentoring in informatics, process improvement, and trial design, will ensure Dr. Schnipper's development as an independent researcher in improving the quality of care of patients with CAD.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HL072806-04
Application #
7113143
Study Section
Special Emphasis Panel (ZHL1-CSR-M (F2))
Program Officer
Cooper, Lawton S
Project Start
2003-09-01
Project End
2008-07-31
Budget Start
2006-08-01
Budget End
2007-07-31
Support Year
4
Fiscal Year
2006
Total Cost
$133,920
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Bell, Susan P; Schnipper, Jeffrey L; Goggins, Kathryn et al. (2016) Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial. J Gen Intern Med 31:470-7
Wooldridge, Kathleene; Schnipper, Jeffrey L; Goggins, Kathryn et al. (2016) Refractory primary medication nonadherence: Prevalence and predictors after pharmacist counseling at hospital discharge. J Hosp Med 11:48-51
Cawthon, Courtney; Walia, Sheena; Osborn, Chandra Y et al. (2012) Improving care transitions: the patient perspective. J Health Commun 17 Suppl 3:312-24
Cohen, Marya J; Shaykevich, Shimon; Cawthon, Courtney et al. (2012) Predictors of medication adherence postdischarge: the impact of patient age, insurance status, and prior adherence. J Hosp Med 7:470-5
Linder, Jeffrey A; Schnipper, Jeffrey L; Middleton, Blackford (2012) Method of electronic health record documentation and quality of primary care. J Am Med Inform Assoc 19:1019-24
Schnipper, Jeffrey L; Gandhi, Tejal K; Wald, Jonathan S et al. (2012) Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial. J Am Med Inform Assoc 19:728-34
Kripalani, Sunil; Roumie, Christianne L; Dalal, Anuj K et al. (2012) Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med 157:1-10
Marvanova, Marketa; Roumie, Christianne L; Eden, Svetlana K et al. (2011) Health literacy and medication understanding among hospitalized adults. J Hosp Med 6:488-93
Linder, Jeffrey A; Rigotti, Nancy A; Schneider, Louise I et al. (2011) Clinician characteristics and use of novel electronic health record functionality in primary care. J Am Med Inform Assoc 18 Suppl 1:i87-90
Schnipper, Jeffrey L; Liang, Catherine L; Hamann, Claus et al. (2011) Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge. J Am Med Inform Assoc 18:309-13

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