title: Use of IndiGO individualized clinical guidelines in primary care.
abstract: OBJECTIVE
  To determine if IndiGO individualized clinical guidelines could be implemented in routine practice and assess their effects on care and care experience.
  
  
  METHODS
  Matched comparison observational design. IndiGO individualized guidelines, based on a biomathematical simulation model, were used in shared decision-making. Physicians and patients viewed risk estimates and tailored recommendations in a dynamic user interface and discussed them for 5-10 min. Outcome measures were prescribing and dispensing of IndiGO-recommended medications, changes in physiological markers and predicted 5-year risk of heart attack and stroke, and physician and patient perceptions.
  
  
  RESULTS
  489 patients using IndiGO were 4.9 times more likely to receive a statin prescription than were matched usual care controls (p=0.015). No effect was observed on prescribing of antihypertensive medications, but IndiGO-using patients were more likely to pick up at least one dispensing (p<0.05). No significant changes were observed in blood pressure or serum lipid levels. Predicted risk of heart attack or stroke decreased 1.6% among patients using IndiGO versus 1.0% among matched controls (p<0.01). Physician and patient experiences were positive to neutral.
  
  
  CONCLUSIONS
  We could not assess the separate effects of individualized guidelines, user interface, and physician-patient discussions. Patient selection could have influenced results. The measure of risk reduction was not independent of the individualized guidelines.
  
  
  CONCLUSIONS
  IndiGO individualized clinical guidelines were successfully implemented in primary care and were associated with increases in the use of cardioprotective medications and reduction in the predicted risk of adverse events, suggesting that a larger trial could be warranted.
authors.affiliation: Kaiser Permanente, Care Management Institute, Oakland, California, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Bellows
authors.forename: Samir
authors.initials: S
authors.lastname: Patel
authors.forename: Scott S
authors.initials: SS
authors.lastname: Young
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009203:Myocardial Infarction / Q000517:prevention & control*; D010346:Patient Care Management / Q000592:standards*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D058996:Quality Improvement; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: clinical decision support; electronic health records; patient education; practice guidelines; quality of health care; shared decision making
references.citation: Am J Cardiol. 2008 Nov 1;102(9):1142-5
references.pmid: 18940280
references.citation: J Gen Intern Med. 2003 Dec;18(12):967-76
references.pmid: 14687254
references.citation: PLoS Med. 2006 Jun;3(6):e134
references.pmid: 16737346
references.citation: Ann Intern Med. 2011 May 3;154(9):627-34
references.pmid: 21536939
references.citation: Stud Health Technol Inform. 2004;107(Pt 1):135-9
references.pmid: 15360790
references.citation: J Gen Intern Med. 2002 Apr;17(4):243-52
references.pmid: 11972720
references.citation: Am J Manag Care. 2007 Jul;13(7):418-24
references.pmid: 17620037
references.citation: JAMA. 2002 Oct 9;288(14):1775-9
references.pmid: 12365965
references.citation: Health Serv Res. 2006 Feb;41(1):1-8
references.pmid: 16479681
references.citation: Int J Med Inform. 2010 Jun;79(6):430-7
references.pmid: 20378396
references.citation: Perm J. 2007 Summer;11(3):12-20
references.pmid: 21461107
references.citation: Eur J Cardiovasc Prev Rehabil. 2006 Oct;13(5):839-45
references.pmid: 17001227
references.citation: Circulation. 2005 Feb 1;111(4):499-510
references.pmid: 15687140
references.citation: Lancet. 2010 Apr 17;375(9723):1365-74
references.pmid: 20356621
references.citation: Inform Prim Care. 2008;16(2):79-91
references.pmid: 18713524
references.citation: Ann Intern Med. 2005 Aug 16;143(4):251-64
references.pmid: 16103469
references.citation: Med Care. 1989 Mar;27(3 Suppl):S110-27
references.pmid: 2646486
references.citation: Diabetes Care. 2003 May;26(5):1497-500
references.pmid: 12716811
references.citation: BMJ. 1996 Jan 13;312(7023):71-2
references.pmid: 8555924
references.citation: Ann Intern Med. 2010 Jan 19;152(2):69-77
references.pmid: 20083825
references.citation: Diabetes Care. 2008 Aug;31(8):1670-1
references.pmid: 18509203
references.citation: Curr Med Res Opin. 2010 Dec;26(12):2779-93
references.pmid: 21050061
references.citation: Ann Fam Med. 2008 May-Jun;6(3):218-27
references.pmid: 18474884
references.citation: JAMA. 2002 Oct 16;288(15):1909-14
references.pmid: 12377092
references.citation: Med Care. 1999 Jan;37(1):5-14
references.pmid: 10413387
references.citation: Am J Med Qual. 2009 May-Jun;24(3):241-9
references.pmid: 19332865
references.citation: Ann Intern Med. 1985 Apr;102(4):520-8
references.pmid: 3977198
references.citation: Diabetes Care. 2003 Nov;26(11):3102-10
references.pmid: 14578246
references.citation: Perm J. 2006 Summer;10(2):72-9
references.pmid: 21519446
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):323-33
references.pmid: 19275987
references.citation: Health Aff (Millwood). 2008 Sep-Oct;27(5):1429-41
references.pmid: 18780934
references.citation: Ann Intern Med. 2011 May 3;154(9):638-9
references.pmid: 21536940
references.citation: Health Aff (Millwood). 2012 Nov;31(11):2441-50
references.pmid: 23129674
references.citation: Popul Health Manag. 2011 Feb;14(1):3-9
references.pmid: 20658943
references.citation: Eff Clin Pract. 1998 Aug-Sep;1(1):2-4
references.pmid: 10345255
references.citation: Implement Sci. 2012 Jul 04;7:62
references.pmid: 22762242
references.citation: Circulation. 2008 Jul 29;118(5):576-85
references.pmid: 18606915
references.citation: J Am Board Fam Pract. 2002 Jan-Feb;15(1):25-38
references.pmid: 11841136
references.citation: J Am Med Inform Assoc. 2011 May 1;18(3):327-34
references.pmid: 21422100
references.citation: Am J Manag Care. 2010 Oct 01;16(10):e256-66
references.pmid: 20964477
references.citation: Diabetes Care. 2003 Nov;26(11):3093-101
references.pmid: 14578245
references.citation: CMAJ. 1995 May 1;152(9):1423-33
references.pmid: 7728691