Electronic alerts do not increase risk-appropriate care for patients with chest pain
Health Information Technology
Evaluation of chest pain represents a significant diagnostic challenge for primary care physicians in that the physician wants to avoid missing a patient’s risk of heart attack, while at the same time limit excess testing. Providing clinicians with electronic alerts with real-time information to promote risk-appropriate clinical decisions did not affect the tests used for high-risk and low-risk primary care patients, found a new study. Doctors who received the alerts had no significant difference in tests used than doctors who did not receive the alerts.
A team led by Thomas D. Sequist, M.D., of Brigham and Women’s Hospital developed a set of two electronic alerts based on automated calculation of the patient’s Framingham Risk Score at the time of the office visit. During the office visits for high-risk patients, clinicians received an alert recommending the performance of an electrocardiogram and the administration of aspirin. The alerts allowed for a "one-click" ordering of these recommendations. During office visits for low-risk patients complaining of chest pain, clinicians ordering cardiac stress tests received an alert recommending against performance of this test.
The study included 215 physicians, nurse practitioners, and physician assistants practicing across 15 health centers that are a part of integrated multispecialty group practice. Over 7,000 of their patients were included in the study. These patients were at least 30 years old on the first occasion of their presenting with chest pain to clinicians. This study was supported by the Agency for Healthcare Research and Quality (HS17075).
See "Electronic risk alerts to improve primary care management of chest pain: A randomized, controlled trial," by Dr. Sequist, Shane M. Morong, B.S., Amy Marston, B.A., and others in the Journal of General Internal Medicine 27(4), pp. 438-444, 2012.