title: Electronic health record-based assessment of cardiovascular health: The stroke prevention in healthcare delivery environments (SPHERE) study.
abstract: < 3% of Americans have ideal cardiovascular health (CVH). The primary care encounter provides a setting in which to conduct patient-provider discussions of CVH. We implemented a CVH risk assessment, visualization, and decision-making tool that automatically populates with electronic health record (EHR) data during the encounter in order to encourage patient-centered CVH discussions among at-risk, yet under-treated, populations. We quantified five of the seven CVH behaviors and factors that were available in The Ohio State University Wexner Medical Center's EHR at baseline (May-July 2013) and compared values to those ascertained at one-year (May-July 2014) among intervention (n = 109) and control (n = 42) patients. The CVH of women in the intervention clinic improved relative to the metrics of body mass index (16% to 21% ideal) and diabetes (62% to 68% ideal), but not for smoking, total cholesterol, or blood pressure. Meanwhile, the CVH of women in the control clinic either held constant or worsened slightly as measured using those same metrics. Providers need easy-to-use tools at the point-of-care to help patients improve CVH. We demonstrated that the EHR could deliver such a tool using an existing American Heart Association framework, and we noted small improvements in CVH in our patient population. Future work is needed to assess how to best harness the potential of such tools in order to have the greatest impact on the CVH of a larger patient population.
authors.affiliation: The Ohio State University College of Public Health, Columbus, OH 43210, United States; The Ohio State University College of Medicine, Columbus, OH 43210, United States.
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
authors.affiliation: The Ohio State University College of Public Health, Columbus, OH 43210, United States.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Shoben
authors.affiliation: The Ohio State University College of Medicine, Columbus, OH 43210, United States.
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Kelley
authors.affiliation: The Ohio State University College of Medicine, Columbus, OH 43210, United States.
authors.forename: Albert M
authors.initials: AM
authors.lastname: Lai
authors.affiliation: The Ohio State University College of Medicine, Columbus, OH 43210, United States; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Lopetegui
authors.affiliation: The Ohio State University College of Medicine, Columbus, OH 43210, United States.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Jackson
authors.affiliation: The Ohio State University College of Medicine, Columbus, OH 43210, United States.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Langan
authors.affiliation: The Ohio State University College of Public Health, Columbus, OH 43210, United States; The Ohio State University College of Medicine, Columbus, OH 43210, United States.
authors.forename: Philip R O
authors.initials: PR
authors.lastname: Payne
keywords: 95% CI, 95% confidence interval; ACC, American College of Cardiology; AHA, American Heart Association; CDS, clinical decision support; CVH, cardiovascular health; Disease management; EHR, electronic health record; GEE, generalized estimation equation; Health outcomes; Medical informatics; OSUWMC, Ohio State University Wexner Medical Center; Prevention; Primary care; SD, standard deviation; SPHERE, stroke prevention in healthcare delivery environments