Decision Support Tools Did Not Reduce Disparities in CVD Prevention

By Rebecca Araujo - Last Updated: August 19, 2023

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Clinical decision support tools were not found to significantly reduce race- and sex-based disparities in preventative care for cardiovascular disease (CVD), according to a study in JAMA Network Open. The cross-sectional study evaluated the use of these tools in primary care practices in the US.

The researchers evaluated 4 measures for secondary preventative care and CVD management: aspirin use for at-risk adults between 40 and 59 years; blood pressure control for hypertension; cholesterol management; and smoking cessation counseling. These 4 quality metrics were named the “ABCS” of CVD prevention by the Million Hearts Initiative.

Clinical decision support tools evaluated in the study included electronic health record (EHR) prompts, standing orders, and clinical registries. “Prompts in the EHR and standing orders are point-of-care tools that guide clinician and care team behavior. Clinical registries help manage chronic conditions by identifying services due and gaps in care or tracking patient progress,” the authors explained.

Data from 576 primary care centers in 12 states were included in the analysis. Survey and HER-derived ABCS data were analyzed to estimate practice-level disparities between Black and White patients and male and female patients regarding the proportion of eligible patients meeting ABCS quality metrics. Thirty-eight percent of practices had patient panels that were more than half White, and 56.8% were more than half female.

More White than Black patients were meeting the blood pressure and cholesterol management metrics, with a difference of 5.16% for blood pressure (p<.001) and 1.49% for cholesterol management (p=.04). More men were meeting metrics for aspirin use and cholesterol management than women, with differences of 4.36% (p<.001) and 3.88% (p<.001), respectively. Conversely, more women were meeting blood pressure control and smoking cessation metrics than men, with differences of -1.8% (p<.001) and -1.67% (p<.001), respectively.

Notably, federally qualified health centers (FQHCs) had “moderately fewer disparities” than non-FQHCs, and FQHCs had the only instance of a higher proportion of Black patients meeting the smoking cessation metric than White patients (difference, -1.99%; p=.02). “This may be a function of several factors, including FQHCs’ comprehensive primary care and enabling services, and differences in Centers for Medicare & Medicaid Services reporting requirements and reimbursement structures compared with non-FQHCs,” the authors noted.

Compared with practices that did not use clinical decision support tools, varying racial disparities persisted among practices that used ABCS metrics. However, the authors noted that these differences were not statistically significant. For the most part, the use of clinical decision support tools was not associated with differences in sex-based disparities, except for smoking cessation. In 1 of 3 practices where chronic care guidelines were included in HER prompts and standing orders, men received higher levels of smoking cessation counseling than women (p=.009).

The authors pointed out some study limitations, including the limited sample size, lack of individual patient data, and missing data on individual ABCS metrics at certain clinics (eg, lack of smoking cessation counseling data from a particular center). Although the researchers initially hypothesized that using clinical decision support tools would reduce disparities in ABCS metrics, they concluded that their hypothesis “was not supported, possibly because having registries or prompts may not equate with consistent use, or because even if a practice uses clinical decision support tools, Black patients may have additional access barriers to care.”

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