The evaluation of ambulatory patients with chest pain is a challenging and serious? problem, accounting for a significant proportion of all outpatient visits. High risk patients may go? undetected, resulting in missed diagnoses of acute myocardial ischemia, while low risk patients? may be subject to unnecessary evaluations. To substantially improve the evaluation and? treatment of outpatients with acute chest pain syndromes, new strategies need to be developed? in the primary care setting to risk stratify symptomatic patients and direct appropriate care.? This study will implement and evaluate electronic risk alerts to risk stratify outpatients? with chest pain and present this information to primary care clinicians within the context of an? electronic health record. The intervention will take place within Harvard Vanguard Medical? Associates, a multispecialty integrated group practice with 140 primary care physicians caring? for approximately 300,000 patients at 14 centers in eastern Massachusetts. With a randomized,? controlled study design, the study has three specific aims:? 1) To identify predictors of risk-appropriate evaluation and treatment of patients presenting to? primary care offices with acute chest pain, including race and sex.? 2) To determine whether rates of appropriate evaluation and treatment of patients with acute? chest pain can be improved through the use of point-of-care electronic risk alerts that? provide individual patient cardiac risk profiles and tailored evaluation and treatment? recommendations to primary care clinicians.? 3) To perform a cost analysis for the provision of electronic decision support for patients with? acute chest pain.? This study has important implications for determining how the treatment of outpatients? with chest pain syndromes can be optimized through the innovative use of electronic decision? support, while documenting the cost implications of such a strategy. This work will also provide? a model for how ambulatory practices across the country can use electronic health records to? present real-time patient risk information to clinicians with the goal of improving patient safety? and quality, which has important implications for both acute and chronic care.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18HS017075-02
Application #
7491063
Study Section
Special Emphasis Panel (ZHS1-HSR-A (01))
Program Officer
Basu, Joy
Project Start
2007-09-01
Project End
2010-08-31
Budget Start
2008-09-01
Budget End
2009-08-31
Support Year
2
Fiscal Year
2008
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Sequist, Thomas D; Morong, Shane M; Marston, Amy et al. (2012) Electronic risk alerts to improve primary care management of chest pain: a randomized, controlled trial. J Gen Intern Med 27:438-44
Allen, Adrienne S; Orav, Endel John; Lee, Thomas H et al. (2011) Clinician personality and the evaluation of higher-risk patient symptoms. J Patient Saf 7:122-6