TY - JOUR
T1 - Clinician use of the Statin Choice Shared Decision-making Encounter Tool in a Major Health System
AU - Martinez, Kathryn A.
AU - Montori, Victor M.
AU - Rodriguez, Fatima
AU - Tereshchenko, Larisa G.
AU - Kovach, Jeffrey D.
AU - Hurwitz, Heather Mc Kee
AU - Rothberg, Michael B.
N1 - Publisher Copyright:
© 2024, The Author(s), under exclusive licence to Society of General Internal Medicine.
PY - 2024
Y1 - 2024
N2 - Background: Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice. Objective: To describe real-world use of an SDM encounter tool for statin prescribing, Statin Choice, embedded into the workflow of an electronic health record. Design: Cross-sectional study. Participants: Clinicians and their statin-eligible patients who had outpatient encounters between January 2020 and June 2021 in Cleveland Clinic Health System. Main Measures: Clinician use of Statin Choice was recorded within the Epic record system. We categorized each patient’s 10-year atherosclerotic cardiovascular disease risk into low (< 5%), borderline (5–7.5%), intermediate (7.5–20%), and high (≥ 20%). Other patient factors included age, sex, insurance, and race. We used mixed effects logistic regression to assess the odds of using Statin Choice for statin-eligible patients, accounting for clustering by clinician and site. We generated a residual intraclass correlation coefficient (ICC) to characterize the impact of the clinician on Statin Choice use. Key Results: Statin Choice was used in 7% of 68,505 eligible patients. Of 1047 clinicians, 48% used Statin Choice with ≥ 1 patient, and these clinicians used it with a median 9% of their patients (interquartile range: 3–22%). In the mixed effects logistic regression model, patient age (adjusted OR per year: 1.04; 95%CI 1.03–1.04) and 10-year ASVCD risk (aOR for 5–7.5% versus < 5% risk: 1.28; 95%CI: 1.14–1.44) were associated with use of Statin Choice. Black versus White race was associated with a lower odds of Statin Choice use (aOR: 0.83; 95%CI: 0.73–0.95), as was female versus male sex (aOR: 0.83; 95%CI: 0.76–0.90). The model ICC demonstrated that 53% of the variation in use of Statin Choice was clinician-driven. Conclusions: Patient factors, including race and sex, were associated with clinician use of Statin Choice; half the variation in use was attributable to individual clinicians.
AB - Background: Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice. Objective: To describe real-world use of an SDM encounter tool for statin prescribing, Statin Choice, embedded into the workflow of an electronic health record. Design: Cross-sectional study. Participants: Clinicians and their statin-eligible patients who had outpatient encounters between January 2020 and June 2021 in Cleveland Clinic Health System. Main Measures: Clinician use of Statin Choice was recorded within the Epic record system. We categorized each patient’s 10-year atherosclerotic cardiovascular disease risk into low (< 5%), borderline (5–7.5%), intermediate (7.5–20%), and high (≥ 20%). Other patient factors included age, sex, insurance, and race. We used mixed effects logistic regression to assess the odds of using Statin Choice for statin-eligible patients, accounting for clustering by clinician and site. We generated a residual intraclass correlation coefficient (ICC) to characterize the impact of the clinician on Statin Choice use. Key Results: Statin Choice was used in 7% of 68,505 eligible patients. Of 1047 clinicians, 48% used Statin Choice with ≥ 1 patient, and these clinicians used it with a median 9% of their patients (interquartile range: 3–22%). In the mixed effects logistic regression model, patient age (adjusted OR per year: 1.04; 95%CI 1.03–1.04) and 10-year ASVCD risk (aOR for 5–7.5% versus < 5% risk: 1.28; 95%CI: 1.14–1.44) were associated with use of Statin Choice. Black versus White race was associated with a lower odds of Statin Choice use (aOR: 0.83; 95%CI: 0.73–0.95), as was female versus male sex (aOR: 0.83; 95%CI: 0.76–0.90). The model ICC demonstrated that 53% of the variation in use of Statin Choice was clinician-driven. Conclusions: Patient factors, including race and sex, were associated with clinician use of Statin Choice; half the variation in use was attributable to individual clinicians.
KW - decision aids
KW - physician variation
KW - primary prevention
KW - shared decision-making
KW - statins
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U2 - 10.1007/s11606-023-08597-3
DO - 10.1007/s11606-023-08597-3
M3 - Article
AN - SCOPUS:85181680009
SN - 0884-8734
JO - Journal of general internal medicine
JF - Journal of general internal medicine
ER -