- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03001713
CV Wizard: Does a Clinical Decision Support Tool Improve CVD Risk Factor Control in Safety Net Clinics? (CV_WIZARD)
CV Wizard: Does a Prioritized, Point-of-Care Clinical Decision Support Tool Improve Guideline-Based CVD Risk Factor Control in Safety Net Clinics?
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The investigators seek to learn whether clinical decision support (CDS) systems from well-resourced care settings are effective in safety net community health centers (CHCs), and how to enhance such cross-setting implementation. Thus, the investigators propose a clinic-randomized, pragmatic trial of the uptake and impact of the 'CV Wizard' CDS tool in 60 CHCs that share a linked electronic health record. CV Wizard summarizes each patient's reversible CVD risks, generates prioritized, guideline-based care recommendations based on those risks, and shows these in a 'provider view' and a 'patient view,' enabling patient engagement. Use rates and satisfaction with this CDS were high in the large healthcare delivery system where it was developed and tested. The investigators will: study its impact in the CHC setting, assess uptake of the CDS system, assess strategies for integrating it into CHC workflows, and its impact on patients' CVD risk and risk factor management. The investigators hypothesize that this cutting-edge CDS will improve rates of guideline-based CVD preventive care in CHC patients, who experience disparities in CVD risk factors, care and outcomes. The 60 study clinics will be members of OCHIN, Inc., a non-profit health center-controlled network and national leader in health information technology for CHCs. OCHIN's leadership enthusiastically supports the proposed work and will help ensure that recruitment goals are met. The investigators will partner with stakeholders / medical leadership from OCHIN's member clinics at every step, via existing structures. This study addresses gaps in guideline-based CVD care in high-risk populations, using targeted, multi-level strategies; considers setting-specific needs; tests how CDS affects guideline implementation in community clinics; and uses technology to support patient engagement. Results will yield knowledge about providing CHCs with cutting-edge CDS, and associated impacts on CVD disparities. The innovative study is the second trial to implement CDS tools from private care settings in CHCs, and the first to do so with complex CDS tools that address a range of CVD risk management guidelines, make prioritized care recommendations, and facilitate point-of-care patient engagement. Results could lead to substantial improvements in CVD prevention, care, and outcomes in CHCs nationwide.
Our overarching aims are to:
Aim 1. Conduct a clinic-randomized trial of the impact of an evidence-based point-of-care CDS system on (i) overall CVD risk scores, and (ii) control of individual CVD risks (blood pressure; HbA1c, lipid levels; aspirin use; smoking; body mass index), among high CVD risk CHC adult patients. H1: High CVD risk patients in Arm 1 CHCs will have significantly lower overall CVD risk scores over a 12-month post-index visit period, compared to those in Arm 2 CHCs. H2: High CVD risk patients in Arm 1 CHCs who have poor control of specific CVD risk factors at an index visit will have significantly better control of those factors over a 12 month post-index visit period, compared to those in Arm 2 CHCs. H3: Disparities in specific CVD risk factor control between CHC patients' versus national CVD risk factor control rates will be significantly reduced by 18 months post-implementation in each Arm (secondary analysis).
Aim 2. Develop and hone need-based implementation support protocols to help Arm 1 CHCs implement the CV Wizard CDS system into their standard workflows; assess whether use of the protocols developed for Arm 1 CHCs accelerates implementation and adoption of the CDS system in the Arm 2 CHCs. H4: CDS uptake into CHC workflows will be significantly faster in Arm 2 CHCs than in Arm 1 CHCs.
Aim 3. Conduct a mixed methods process evaluation, guided by the Technology Acceptance Model, to identify and address patient, provider, and delivery system barriers to uptake / impact of this CDS in CHCs.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Oregon
-
Portland, Oregon, United States, 97227
- Kaiser Permanente Center for Health Research
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adult clinic attendees with high CVD risk, including women and minorities
- Persons aged 18-21 with high-CVD risk
- Some subjects with mental health conditions of various types
Exclusion Criteria:
-Children aged younger than 18
Note: The investigators are not enrolling patients for this clinic-randomized study, but rather studying the uptake and impact of a set of EHR-based clinical decision support tools into regular care at the participating clinics. In this clinic-randomized trial, the intervention / randomization are clinic level.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Arm 1: Immediate implementation
30 safety net community health centers (CHCs) will be randomized to implement the sophisticated CV Wizard clinical decision support (CDS) system at the start of study year 2. Arm 1 CHCs will receive implementation support that will be pragmatically iterated to address any barriers to adoption / sustained use of the CDS that are identified through study activities.
The investigators will apply these learnings to improve adoption rates in Arm 2.
|
This project will determine whether a sophisticated CDS system will be effective in CHCs.
The innovative, point-of-care, web-based CDS system we will test ("CV Wizard") generates a guideline-based prioritized summary of each patient's major CVD risk factors, then presents patient and provider 'views' of this summary, with individualized care recommendations.
|
Active Comparator: Arm 2: Delayed implementation
30 safety net community health centers (CHCs) will be randomized to implement the sophisticated CV Wizard clinical decision support (CDS) system 18 months later than Arm 1.
The investigators will measure the intervention's impact on CVD risk factor control in CHCs.
|
This project will determine whether a sophisticated CDS system will be effective in CHCs.
The innovative, point-of-care, web-based CDS system we will test ("CV Wizard") generates a guideline-based prioritized summary of each patient's major CVD risk factors, then presents patient and provider 'views' of this summary, with individualized care recommendations.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Comparison of CVD outcomes for patients in CHCs
Time Frame: Up to 36 months
|
Compare patients' CVD outcomes in the 30 Arm 1 vs. 30 Arm 2 CHCs, in months 13-30 (Aim 1); assess whether the revised implementation support materials expedite CDS adoption (Aim 2); and use mixed methods to identify multi-level barriers / facilitators to adoption of the CDS tool (Aim 3).
|
Up to 36 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Reach: Encounters affected
Time Frame: Up to 36 months
|
% clinic encounters where CV Wizard suggests running the full risk assessment tool, i.e., identified a target patient.
|
Up to 36 months
|
Effectiveness (impact): Patient outcomes - 10 year pooled ASCVD risk score
Time Frame: Up to 36 months
|
(i) ASCVD risk score (American College of Cardiology-ACC/ American Heart Association - AHA) 10-year pooled ASCVD risk score, 40-75 year olds
|
Up to 36 months
|
Effectiveness (impact): Patient outcomes - Framingham 30-year CVD risk score
Time Frame: Up to 36 months
|
(i) Framingham 30-year CVD risk score, 20-39 year olds.
|
Up to 36 months
|
Effectiveness (impact): Patient outcomes - last BP ≤140/90
Time Frame: Up to 36 months
|
(ii) Control of individual CVD risk factors: last BP ≤140/90
|
Up to 36 months
|
Effectiveness (impact): Patient outcomes - last A1c≤8
Time Frame: Up to 36 months
|
(ii) Control of individual CVD risk factors: last A1c≤8
|
Up to 36 months
|
Effectiveness (impact): Patient outcomes - last LDL<100
Time Frame: Up to 36 months
|
(ii) Control of individual CVD risk factors: last LDL<100
|
Up to 36 months
|
Effectiveness (impact): Patient outcomes - appropriate aspirin use
Time Frame: Up to 36 months
|
(ii) Control of individual CVD risk factors: appropriate aspirin use
|
Up to 36 months
|
Effectiveness (impact): Patient outcomes - not current smoker
Time Frame: Up to 12 months
|
(ii) Control of individual CVD risk factors: not current smoker
|
Up to 12 months
|
Effectiveness (impact): Patient outcomes - last BMI ≤25
Time Frame: Up to 36 months
|
(ii) Control of individual CVD risk factors: last BMI≤25
|
Up to 36 months
|
Effectiveness (impact): Patient outcomes - appropriate cardioprotective medications
Time Frame: Up to 36 months
|
(ii) Control of individual CVD risk factors: appropriate cardioprotective prescriptions (e.g., statins).
|
Up to 36 months
|
Adoption: CDS uptake
Time Frame: Up to 36 months
|
% of encounters where care team member opts to run the CV Wizard risk assessment.
|
Up to 36 months
|
Implementation: User perceptions
Time Frame: Up to 36 months
|
Perceived ease of use, usefulness, acceptability of CV Wizard; intent to use it.
|
Up to 36 months
|
Maintenance over time
Time Frame: Up to 36 months
|
All measures over 2.5 years of follow-up, Arm 1; 1.5 years, Arm 2.
|
Up to 36 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Rachel Gold, PhD, MPH, Kaiser Permanente
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HL133793-01A1
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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