The proposed research seeks to determine whether physician-targeted, technology-assisted academic detailing can improve adherence to American College of Cardiology/American Heart Association (ACC/AHA) Coronary Heart Disease (CHD) secondary prevention guidelines and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) cholesterol-lowering guidelines. The long-term objective is to develop a generalizable model for implementing national health care guidelines, taking advantage of teachable moments for physicians caring for hospitalized patients.
The specific aim of this research is to assess whether the proposed intervention will improve adherence to ACC/AHA CHD and NCEP ATP III cholesterol lowering guidelines for hospitalized patients with CHD and CHD risk equivalents. The study employs a randomized, controlled, two-period parallel design comparing technology-assisted academic detailing to existing practice at the study institutions. All patients admitted over a four-year period to the medical, vascular surgery, and cardiothoracic surgery services of a large Midwestern teaching facility and a community hospital will be studied. This represents a diverse physician and patient population. The physicians include those in private practice, full and part-time academic physicians, and physicians-in-training in various medical and surgical specialties and at varying stages post-training. There is a diverse payor mix, with the largest group being Medicare. The primary outcome measures are physician adherence to ACC/AHA CHD secondary prevention and NCEP ATP III cholesterol lowering guidelines at hospital discharge. We expect to determine the feasibility and effectiveness of this approach for a large, busy, academic medical center and a community hospital that currently do not have computerized physician order entry (CPOE). This is applicable to the majority of medical centers in the US. The alerting rules we develop will also be valuable to those centers implementing CPOE.
