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Table 2 Provider experience in delivering care to adult patients at high risk of cardiovascular disease or diabetes

From: Clinician perceptions of a clinical decision support system to reduce cardiovascular risk among prediabetes patients in a predominantly rural healthcare system

Response

Measure

Question

Pre-implementation

p-value

Post-implementation

p-value

Treatment by time interaction p-value

CDS

UC

CDS

UC

n = 102

n = 60

n = 78

n = 53

  

Please mark the response that best fits your experience in providing care to adult patients who are at high risk of cardiovascular disease or diabetes

       

0–10

Always

At typical clinic visits for non-acute illnesses, how often do you discuss CV risk reduction with your patients? n (% Always)

74 (72.5)

50 (83.3)

0.1177

53 (70.7)

39 (75.0)

0.5910

0.2449

0–10

Always

At these typical clinic visits, how well prepared do you feel to prioritize CV risk factors and discuss them with your patients? n (% Always)

79 (78.2)

47 (78.3)

0.9863

60 (80.0)

42 (82.4)

0.7413

0.3152

0–10

Always

At these typical clinic visits, how often do you use CV risk calculations while seeing patients? n (% Always)

46 (45.1)

17 (28.3)

0.0345

39 (52.0)

23 (45.1)

0.4469

0.3990

  

When you use a CV risk calculator for patient care, which source do you use most often?

  

0.3465

  

0.9029

 
  

Use a smartphone-based calculator (i.e., an App), n (%)

18 (17.6)

11 (18.3)

 

9 (11.8)

7 (13.5)

  
  

Use a link within the Epic EMR to a CV risk calculator, n (%)

61 (59.8)

30 (50.0)

 

52 (68.4)

33 (63.5)

  
  

Use a web-based calculator (not linked through the Epic EMR), n (%)

6 (5.9)

8 (13.3)

 

8 (10.5)

4 (7.7)

  

0–10

Always

At typical clinic visits for non-acute illnesses, how often do you discuss prevention of diabetes with your patients? n (% Always)

61 (60.4)

42 (70.0)

0.2197

43 (57.3)

33 (63.5)

0.4885

0.6865

0–100%

 

What percentage of the time, from 0% to 100%, do you feel patients initiate conversations with you about risk factors for developing diabetes or heart disease? (95% Cl)

(23.6, 31.4)

(21.2, 31.1)

0.6707

(24.1, 33.0)

(18.9, 30.4)

0.2748

0.6539

0–10

Easy

At these typical clinical visits, how easy is it to follow aspirin guidelines to determine if a patient will benefit from taking aspirin for primary prevention (e.g., US Preventive Services Task Force recommendations)? n (% Easy)

45 (44.6)

28 (47.5)

0.7221

29 (38.2)

27 (51.9)

0.1231

0.7072

0–10

Well prepared

At typical clinic visits for patients with prediabetes, how well prepared do you feel to discuss metformin or other glucose-lowering medications for preventing diabetes or reducing CV risk? n (% Well prepared)

67 (65.7)

43 (71.7)

0.4311

64 (84.2)

40 (80.0)

0.5425

0.4500

0–10

Well prepared

At typical clinic visits for patients with prediabetes, how well prepared do you feel to discuss dietary and physical activity recommendations for preventing diabetes or reducing CV Risk? n (% Well prepared)

96 (95.0)

52 (88.1)

0.1092

74 (97.4)

45 (90.0)

0.0773

0.6382

0–10

Important

How important do you feel it is to screen adult patients at risk for prediabetes? n (% Important)

93 (91.2)

56 (93.3)

0.6256

72 (94.7)

46 (92.0)

0.5377

0.8049

0–10

Important

If a patient is in the prediabetes blood glucose range, how important is it to provide a diagnosis of prediabetes (i.e., add to the problem list and/or use ICD-10 diagnostic code)? n (% Important)

79 (78.2)

52 (86.7)

0.1831

65 (85.5)

42 (84.0)

0.8148

0.5471

0–10

Important

How important do you feel it is to talk to patients with prediabetes who are less than 65 years of age about use of metformin or other glucose-lowering medications? n (% Important)

62 (60.8)

43 (71.7)

0.1613

55 (73.3)

32 (64.0)

0.2664

0.4503