Electronic risk alerts to improve primary care management of chest pain: A randomized, controlled trial

Journal of General Internal Medicine

Volumn 27, Issue 4, 2012, Pages 438-444

  Sequist, Thomas D ^a,b,c   Morong, Shane M ^a   Marston, Amy ^c   Keohane, Carol A ^a   Cook, E Francis ^a   Orav, E John ^a   Lee, Thomas H ^a,d  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

^c HARVARD VANGUARD MEDICAL ASSOCIATES   (United States)

^d PARTNERS HEALTHCARE   (United States)

Author keywords

Acute myocardial infarction; Chest pain; Electronic health record; Patient safety; Quality improvement

Indexed keywords

ACETYLSALICYLIC ACID; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BRONCHODILATING AGENT; HISTAMINE H2 RECEPTOR ANTAGONIST; NARCOTIC ANALGESIC AGENT; NITRATE; NONSTEROID ANTIINFLAMMATORY AGENT; PROTON PUMP INHIBITOR;

ACUTE HEART INFARCTION; ADULT; ANGINA PECTORIS; ARTICLE; CARDIOVASCULAR DISEASE; CLINICAL EVALUATION; CLINICAL PROTOCOL; CONTROLLED STUDY; CORONARY ARTERY BYPASS GRAFT; CORONARY ARTERY DISEASE; DIAGNOSTIC TEST ACCURACY STUDY; ELECTROCARDIOGRAM; ELECTRONIC MEDICAL RECORD; EXERCISE TEST; FEMALE; FRAMINGHAM RISK SCORE; GASTROESOPHAGEAL REFLUX; HEALTH CARE QUALITY; HEARTBURN; HIGH RISK PATIENT; HOSPITAL PATIENT; HUMAN; MAJOR CLINICAL STUDY; MALE; MULTICENTER STUDY; OUTCOME ASSESSMENT; PATIENT CARE; PATIENT SAFETY; PHYSICAL EXAMINATION; PHYSICIAN; PRIMARY MEDICAL CARE; RANDOMIZED CONTROLLED TRIAL; RISK ASSESSMENT; RISK FACTOR; SENSITIVITY AND SPECIFICITY; THORAX PAIN; TRANSLUMINAL CORONARY ANGIOPLASTY;

CHEST PAIN; CLINICAL ALARMS; CONFIDENCE INTERVALS; FEMALE; HEALTH CARE SURVEYS; HUMANS; LOGISTIC MODELS; MALE; MIDDLE AGED; MYOCARDIAL INFARCTION; QUALITY OF HEALTH CARE; RISK ASSESSMENT; STATISTICS AS TOPIC; UNITED STATES;

EID: 84862530695     PISSN: 08848734     EISSN: 15251497     Source Type: Journal    
DOI: 10.1007/s11606-011-1911-6     Document Type: Article

References (37)

1. Goldman L, Kirtane AJ. Triage of patients with acute chest pain and possible cardiac ischemia: The elusive search for diagnostic perfection. Ann Intern Med. 2003;139:987-95. (Pubitemid 37523063)
2. Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Engl J Med. 2000;342:1187-95. (Pubitemid 30211051)
3. Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for. Natl Health Stat Rep. 2006;2008:1-29.
4. Sequist TD, Bates DW, Cook EF, et al. Prediction of missed myocardial infarction among symptomatic outpatients without coronary heart disease. Am Heart J. 2005;149:74-81. (Pubitemid 40126493)
5. Sequist TD, Marshall R, Lampert S, Buechler EJ, Lee TH. Missed opportunities in the primary care management of early acute ischemic heart disease. Arch Intern Med. 2006;166:2237-43. (Pubitemid 44748770)
6. Lewis WR, Amsterdam EA, Turnipseed S, Kirk JD. Immediate exercise testing of low risk patients with known coronary artery disease presenting to the emergency department with chest pain. J Am Coll Cardiol. 1999;33:1843-7.
7. Buntinx F, Knockaert D, Bruyninckx R, et al. Chest pain in general practice or in the hospital emergency department: Is it the same? Fam Pract. 2001;18:586-9.
8. Hillman BJ, Goldsmith JC. The uncritical use of high-tech medical imaging. N Engl J Med. 2010;363:4-6.
9. Yelland M, Cayley WE Jr, Vach W. An algorithm for the diagnosis and management of chest pain in primary care. Med Clin N Am. 2010;94:349-74.
10. Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL. The rational clinical examination. Is this patient having a myocardial infarction? JAMA. 1998;280:1256-63.
11. Kontos MC, Diercks DB, Kirk JD. Emergency department and officebased evaluation of patients with chest pain. Mayo Clin Proc. 2010;85:284-99.
12. Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med. 2003;348:2526-34. (Pubitemid 36706541)
13. Doust J. Diagnosis in general practice. Using probabilistic reasoning. BMJ. 2009;339:b3823.
14. Snow V, Barry P, Fihn SD, et al. Evaluation of primary care patients with chronic stable angina: guidelines from the American College of Physicians. Ann Intern Med. 2004;141:57-64.
15. National Cholesterol Education Program. Executive summary of the third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285:2486-97.
16. Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150:396-404.
17. Thygesen K, Alpert JS, White HD, et al. Universal definition of myocardial infarction. Circulation. 2007;116:2634-53. (Pubitemid 350182388)
18. Schiff GD, Bates DW. Can electronic clinical documentation help prevent diagnostic errors? N Engl J Med. 2010;362:1066-9.
19. Kaushal R, Jha AK, Franz C, et al. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc. 2006;13:261-6.
20. Jha AK, Chan DC, Ridgway AB, Franz C, Bates DW. Improving safety and eliminating redundant tests: Cutting costs in U.S. hospitals. Health Aff. 2009;28:1475-84.
21. Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med. 2010;363:501-4.
22. Stone EG, Morton SC, Hulscher ME, et al. Interventions that increase use of adult immunization and cancer screening services: A metaanalysis. Ann Intern Med. 2002;136:641-51. (Pubitemid 34462676)
23. Shea S, DuMouchel W, Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc. 1996;3:399-409. (Pubitemid 126445041)
24. Metzger J, Welebob E, Bates DW, Lipsitz S, Classen DC. Mixed results in the safety performance of computerized physician order entry. Health Aff. 2010;29:655-63.
25. Bodenheimer T, Grumbach K. Electronic technology: A spark to revitalize primary care? JAMA. 2003;290:259-64. (Pubitemid 37430067)
26. DesRoches CM, Campbell EG, Vogeli C, et al. Electronic health records' limited successes suggest more targeted uses. Health Aff. 2010;29:639-46.
27. Bates DW, Kuperman GJ, Wang S, et al. Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003;10:523-30. (Pubitemid 37377461)
28. Gencer B, Vaucher P, Herzig L, et al. Ruling out coronary heart disease in primary care patients with chest pain: A clinical prediction score. BMC Med. 2010;8:9.
29. Lee TH, Pearson SD, Johnson PA, et al. Failure of information as an intervention to modify clinical management. A time-series trial in patients with acute chest pain. Ann Intern Med. 1995;122:434-7.
30. Bosner S, Haasenritter J, Becker A, et al. Ruling out coronary artery disease in primary care: Development and validation of a simple prediction rule. CMAJ. 2010;182:1295-300.
31. Miller CD, Lindsell CJ, Khandelwal S, et al. Is the initial diagnostic impression of "noncardiac chest pain" adequate to exclude cardiac disease? Ann Emerg Med. 2004;44:565-74. (Pubitemid 39573172)
32. Conti A, Vanni S, Taglia BD, et al. A new simple risk score in patients with acute chest pain without existing known coronary disease. Am J Emerg Med. 2010;28:135-42.
33. Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: A study of closed malpractice claims. Ann Intern Med. 2006;145:488-96. (Pubitemid 46780952)
34. Gandhi TK, Lee TH. Patient safety beyond the hospital. N Engl J Med. 2010;363:1001-3.
35. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163-70. (Pubitemid 30211047)
36. Gaal S, Verstappen W, Wensing M. Patient safety in primary care: A survey of general practitioners in The Netherlands. BMC Health Serv Res. 2010;10:21.
37. Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA guidelines for exercise testing: Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation. 1997;96:345-54.