Effect of Clinical Decision Support on Cardiovascular Risk Among Adults With Bipolar Disorder, Schizoaffective Disorder, or Schizophrenia

• DOI: 10.1001/jamanetworkopen.2022.0202
• Publication Date: 2022-03-07T16:02:42Z
• Authors: Rebecca C. Rossom; A. Lauren Crain; Patrick J. O’Connor; Stephen C. Waring; Stephanie A. Hooker; Kris Ohnsorg; Allise Taran; Kristen M. Kopski; JoAnn M. Sperl-Hi...
• Keywords: Adult; Male; Bipolar Disorder; Middle Aged; Decision Support Systems, Clinical; United States; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Psychotic Disorders; Cardiovascular Diseases; Heart Disease Risk Factors; Risk Factors; Schizophrenia; Humans; Female; Original Investigation

<h3>Importance</h3> Adults with schizophrenia, schizoaffective disorder, or bipolar collectively termed<i>serious mental illness</i>(SMI), have shortened life spans compared people without SMI. The leading cause of death is cardiovascular (CV) disease. <h3>Objective</h3> To assess whether a clinical decision support (CDS) system aimed at primary care clinicians improves CV health for adult patients <h3>Design, Setting, and Participants</h3> In this cluster randomized trial conducted from March 2, 2016, to September 19, 2018, restricted randomization assigned 76 clinics in 3 Midwestern systems receive not CDS improving among Eligible had least 20 SMI; their SMI 1 modifiable risk factor the goal set by American College Cardiology/American Heart Association guidelines were included. Statistical analysis was on an intention-to-treat basis January 10, 2019, December 29, 2021. <h3>Intervention</h3> assessed factors provided personalized treatment recommendations patients. <h3>Main Outcomes Measures</h3> Patient-level change total over 12 months, summed individual (smoking, body mass index, low-density lipoprotein cholesterol level, systolic blood pressure, hemoglobin A_1clevel). <h3>Results</h3> A 80 randomized; 4 excluded having fewer than eligible patients, leaving 42 intervention 34 control clinics. 8937 (4922 women [55.1%]; mean [SD] age, 48.4 [13.5] years) enrolled. There 4% lower rate increase relative (relative ratio [RR], 0.96; 95% CI, 0.94-0.98). favored who 18 29 years age (RR, 0.89; 0.81-0.98) 50 59 0.93; 0.90-0.96), Black 0.88-0.98), White Men 0.94-0.99) 0.95; 0.92-0.97), as well any subtype (bipolar disorder: RR, 0.94-0.99; 0.94; 0.90-0.98; schizophrenia: 0.92; 0.85-0.99) also benefited intervention. Despite effects favoring intervention, there no significant differences factors. <h3>Conclusions Relevance</h3> This resulted that Results driven cumulative incremental mostly nonsignificant changes These findings emphasize value using prompt early adults <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT02451670