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Bangash H, Saadatagah S, Naderian M, Hamed ME, Alhalabi L, Sherafati A, Sutton J, Elsekaily O, Mir A, Gundelach JH, Gibbons D, Johnsen P, Wood-Wentz CM, Smith CY, Caraballo PJ, Bailey KR, Kullo IJ. Effect of clinical decision support for severe hypercholesterolemia on low-density lipoprotein cholesterol levels. NPJ Digit Med 2024; 7:73. [PMID: 38499608 PMCID: PMC10948900 DOI: 10.1038/s41746-024-01069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
Severe hypercholesterolemia/possible familial hypercholesterolemia (FH) is relatively common but underdiagnosed and undertreated. We investigated whether implementing clinical decision support (CDS) was associated with lower low-density lipoprotein cholesterol (LDL-C) in patients with severe hypercholesterolemia/possible FH (LDL-C ≥ 190 mg/dL). As part of a pre-post implementation study, a CDS alert was deployed in the electronic health record (EHR) in a large health system comprising 3 main sites, 16 hospitals and 53 clinics. Data were collected for 3 months before ('silent mode') and after ('active mode') its implementation. Clinicians were only able to view the alert in the EHR during active mode. We matched individuals 1:1 in both modes, based on age, sex, and baseline lipid lowering therapy (LLT). The primary outcome was difference in LDL-C between the two groups and the secondary outcome was initiation/intensification of LLT after alert trigger. We identified 800 matched patients in each mode (mean ± SD age 56.1 ± 11.8 y vs. 55.9 ± 11.8 y; 36.0% male in both groups; mean ± SD initial LDL-C 211.3 ± 27.4 mg/dL vs. 209.8 ± 23.9 mg/dL; 11.2% on LLT at baseline in each group). LDL-C levels were 6.6 mg/dL lower (95% CI, -10.7 to -2.5; P = 0.002) in active vs. silent mode. The odds of high-intensity statin use (OR, 1.78; 95% CI, 1.41-2.23; P < 0.001) and LLT initiation/intensification (OR, 1.30, 95% CI, 1.06-1.58, P = 0.01) were higher in active vs. silent mode. Implementation of a CDS was associated with lowering of LDL-C levels in patients with severe hypercholesterolemia/possible FH, likely due to higher rates of clinician led LLT initiation/intensification.
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Affiliation(s)
- Hana Bangash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Marwan E Hamed
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lubna Alhalabi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alborz Sherafati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph Sutton
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Omar Elsekaily
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ali Mir
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Daniel Gibbons
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Paul Johnsen
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | - Carin Y Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Pedro J Caraballo
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kent R Bailey
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.
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Bangash H, Elsekaily O, Saadatagah S, Sutton J, Johnsen P, Gundelach JH, Kamzabek A, Freimuth R, Caraballo PJ, Kullo IJ. Clinician Perspectives on Clinical Decision Support for Familial Hypercholesterolemia. J Pers Med 2023; 13:929. [PMID: 37373918 DOI: 10.3390/jpm13060929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
Familial Hypercholesterolemia (FH) is underdiagnosed in the United States. Clinical decision support (CDS) could increase FH detection once implemented in clinical workflows. We deployed CDS for FH at an academic medical center and sought clinician insights using an implementation survey. In November 2020, the FH CDS was deployed in the electronic health record at all Mayo Clinic sites in two formats: a best practice advisory (BPA) and an in-basket alert. Over three months, 104 clinicians participated in the survey (response rate 11.1%). Most clinicians (81%) agreed that CDS implementation was a good option for identifying FH patients; 78% recognized the importance of implementing the tool in practice, and 72% agreed it would improve early diagnosis of FH. In comparing the two alert formats, clinicians found the in-basket alert more acceptable (p = 0.036) and more feasible (p = 0.042) than the BPA. Overall, clinicians favored implementing the FH CDS in clinical practice and provided feedback that led to iterative refinement of the tool. Such a tool can potentially increase FH detection and optimize patient management.
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Affiliation(s)
- Hana Bangash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Omar Elsekaily
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Joseph Sutton
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | - Paul Johnsen
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | - Justin H Gundelach
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Arailym Kamzabek
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert Freimuth
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Pedro J Caraballo
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Gonda Vascular Center, Mayo Clinic, Rochester, MN 55905, USA
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Bangash H, Saadatagah S, Alhalabi L, Hamed M, Sherafati A, Sutton J, Elsekaily O, Mir A, Gundelach J, Gibbons D, Johnsen P, Smith C, Wood-Wentz C, Crusan D, Bailey KR, Caraballo P, Kullo IJ. EFFECT OF A CLINICAL DECISION SUPPORT TOOL FOR FAMILIAL HYPERCHOLESTEROLEMIA ON LOW-DENSITY LIPOPROTEIN-CHOLESTEROL LEVELS: A PRE-POST IMPLEMENTATION STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02564-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Johnsen P, Satpathy J, Patel NK, Hansen E, Mounasamy V. Antegrade femoral nailing in the lateral decubitus position: a case series, technical tips and review of literature. Eur J Orthop Surg Traumatol 2023; 33:381-384. [PMID: 35024951 DOI: 10.1007/s00590-021-03200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Femoral intramedullary nailing is traditionally performed with the patient supine on a fracture table. We aimed to describe a case series of femoral intramedullary nailing for fracture in the lateral position, with discussion of the operative technique. METHODS A retrospective analysis identified 52 patients who underwent femoral intramedullary nailing performed in a lateral position without traction over a 5-year period at a single level 1 trauma center. Medical records were reviewed for demographics, blood loss including need for transfusion, operative duration, complications, length of stay, fracture union, re-operation and death. RESULTS There were 24 subtrochanteric, 16 peri-trochanteric and 12 diaphyseal femoral fractures. Mean operative time was 136.2 ± 101.4 min with a mean estimated blood loss of 372.5 ± 349.6 ml. Seventeen patients required blood transfusion. Mean length of stay was 10.3 ± 8.1 days. There were 3 (5.8%) surgical (compartment syndrome, infection and retained drain) and 12 (23.1%) medical complications, with a 30-day mortality rate of 3.8% (2). Mean follow-up was 9.9 ± 8.7 months. The union rate was 94.2% (49) and 3.8% (2) patients required revision fixation (hardware exchange for irritation and exchange nailing for non-union). Discharge destination was home, rehabilitation center and specialized nursing facility in 21 (40.4%), 16 (30.8%) and 15 (28.8%) patients, respectively. DISCUSSION AND CONCLUSION Femoral intramedullary nailing in the lateral decubitus position is a useful technique of managing peri-trochanteric, subtrochanteric and diaphyseal femoral fractures. We describe a known technique with technical tips, which has distinct advantages over traditional supine positioning especially in certain patient and fracture types. In addition, operative times, blood loss, length of stay, revision and outcomes were comparable to the literature.
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Affiliation(s)
- P Johnsen
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - J Satpathy
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - N K Patel
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - E Hansen
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - V Mounasamy
- Virginia Commonwealth University, Richmond, VA, USA.
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Bangash H, Elsekaily O, Gundelach J, Sutton J, Johnsen P, Freimuth R, Caraballo P, Kullo I. Provider Feedback on Implementation of a Genomic Clinical Decision Support for Familial Hypercholesterolemia. J Clin Lipidol 2022. [DOI: 10.1016/j.jacl.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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