Development and pilot feasibility study of a health information technology tool to calculate mortality risk for patients with asymptomatic carotid stenosis: the Carotid Risk Assessment Tool (CARAT)

BMC Medical Informatics and Decision Making

Research Article

Rebecca Horvath¹  Karina A Newhall¹  Melissa L O’Connell¹  Carey Stillman¹  Amy L Hamilton¹  Donald S Likosky²  Adrienne E Faerber³  Philip P Goodney⁴ 

[1] Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA;The Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA;The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, NH, USA;The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, NH, USA;Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA;

关键词: Carotid artery narrowing;    Surgical decision-making;    Health information technology;    Risk calculator;   

DOI  :  10.1186/s12911-015-0141-y

 received in 2014-11-24, accepted in 2015-02-24,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPatients with no history of stroke but with stenosis of the carotid arteries can reduce the risk of future stroke with surgery or stenting. At present, a physicians’ ability to recommend optimal treatments based on an individual’s risk profile requires estimating the likelihood that a patient will have a poor peri-operative outcomes and the likelihood that the patient will survive long enough to gain benefit from the procedure. We describe the development of the CArotid Risk Assessment Tool (CARAT) into a 2-year mortality risk calculator within the electronic medical record, integrating the tool into the clinical workflow, training the clinical team to use the tool, and assessing the feasibility and acceptability of the tool in one clinic setting.MethodsWe modified an existing clinical flowsheet with the local electronic medical record for the CARAT risk model. To understand how CARAT would fit into the existing clinical workflow, we observed the clinic and talked with the clinical staff to develop a process map for the existing clinical workflow. CARAT was completed by the clinic nurse for patients identified on the clinic schedule as having carotid narrowing. We analyzed post-implementation assessment in two ways: quantifying the proportion of eligible patients with whom CARAT was utilized, and surveying surgeons to understand the impact of CARAT on decision-making and clinical workflow.ResultsWith minimum investment of institutional resources, we were able to produce a workable tool and pilot the tool in our clinic within a 6 month time period. Over 4 months, 287 patients were seen in the clinic with carotid narrowing, and clinic staff completed CARAT for 195 (68%). Per-surgeon completion rates ranged from 29 to 81%. Most patients (191 of 195, 98%) patients had a low 2-year calculated mortality risk. Most surgeons believed the risk assessment aligned with their expectations of patient predicted risk.ConclusionsWe successfully integrated CARAT into the existing electronic medical record and have preliminary evidence that CARAT can be a valuable tool for evaluating mortality risk for patients with diseased carotid arteries. Accuracy of the risk calculations must be evaluated in larger, multi-center studies.

【 授权许可】

Unknown   
© Faerber et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.