风险计算越来越多地用于脂质管理,充血性心力衰竭,和心房颤动。然后将风险评分用于决定他汀类药物的使用,抗凝,和植入式除颤器的使用。计算患者的风险并根据这些风险做出决策通常是在护理点完成的,这对临床医生来说是额外的时间负担,可以通过自动化任务和使用临床决策支持来减少。
使用MoraeRecorder软件,我们给30个医疗服务提供者计时,负责计算心血管事件的总体风险,心力衰竭猝死,房颤的血栓事件风险。使用的风险计算器是美国心脏病学会动脉粥样硬化心血管疾病风险计算器(AHA-ASCVD风险),西雅图心力衰竭模型(SHFM风险),和CHA2DS2VASc。我们还对30个提供者使用AskMayoExpert护理过程模型进行脂质管理进行计时,心力衰竭管理,和基于计算的风险评分的心房颤动管理。我们使用梅奥诊所初级保健小组来估计计算整个小组风险的时间。
完成CHA2DS2VASc的平均提供者时间,AHA-ASCVD风险,和SHFM分别为36、45和171s。对于心房颤动的决策,脂质,心力衰竭,平均时间(包括风险计算)分别为85,110和347s.
即使在最好的情况下,供应商需要大量的时间来完成风险评估。对于一个完整的患者小组,这可能导致需要数小时的时间来决定他汀类药物的处方,使用抗凝,和治疗心力衰竭的药物.需要信息学解决方案来捕获医疗记录中的数据,并在护理点为医生和其他提供者提供自动计算的风险评估。
Risk calculation is increasingly used in lipid management, congestive heart failure, and atrial fibrillation. The risk scores are then used for decisions about statin use, anticoagulation, and implantable defibrillator use. Calculating risks for patients and making decisions based on these risks is often done at the point of care and is an additional time burden for clinicians that can be decreased by automating the tasks and using clinical decision-making support.
Using Morae Recorder software, we timed 30 healthcare providers tasked with calculating the overall risk of cardiovascular events, sudden death in heart failure, and thrombotic event risk in atrial fibrillation. Risk calculators used were the American College of Cardiology Atherosclerotic Cardiovascular Disease risk calculator (AHA-ASCVD risk), Seattle Heart Failure Model (SHFM risk), and CHA2DS2VASc. We also timed the 30 providers using Ask Mayo Expert care process models for lipid management, heart failure management, and atrial fibrillation management based on the calculated risk scores. We used the Mayo Clinic primary care panel to estimate time for calculating an entire panel risk.
Mean provider times to complete the CHA2DS2VASc, AHA-ASCVD risk, and SHFM were 36, 45, and 171 s respectively. For decision making about atrial fibrillation, lipids, and heart failure, the mean times (including risk calculations) were 85, 110, and 347 s respectively.
Even under best
case circumstances, providers take a significant amount of time to complete risk assessments. For a complete panel of patients this can lead to hours of time required to make decisions about prescribing statins, use of anticoagulation, and medications for heart failure. Informatics solutions are needed to capture data in the medical record and serve up automatically calculated risk assessments to physicians and other providers at the point of care.