Evidence map›Paper›PMID 39561232›Full record

ArticleCirculation. Cardiovascular quality and outcomes2024

Electronic Health Record Alert to Promote Adoption of Limited Transthoracic Echocardiograms in Primary Care and Cardiology Clinics: A Mixed Methods Evaluation.

Neil M Kalwani, Samantha M R Kling, Stacie Vilendrer, Donn W Garvert, Darlene Veruttipong, Juliana Baratta, Erika A Saliba-Gustafsson, Eleanor Levin, Cindie Gaspar, Cati G Brown-Johnson and 2 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Cardiovascular quality and outcomes, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Neil M KalwaniCardiology Section, Medical Service, VA Palo Alto Health Care System, Palo Alto, CA (N.M.K.).ORCID 0000-0003-0075-6206
Samantha M R Kling *Division of Primary Care and Population Health, Department of Medicine (S.M.R.K., S.V., D.W.G., D.V., J.B., E.A.S.-G., C.G.B.-J., S.A.T., M.W.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0001-9169-763X
Stacie VilendrerDivision of Primary Care and Population Health, Department of Medicine (S.M.R.K., S.V., D.W.G., D.V., J.B., E.A.S.-G., C.G.B.-J., S.A.T., M.W.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0003-2317-5973
Donn W GarvertDivision of Primary Care and Population Health, Department of Medicine (S.M.R.K., S.V., D.W.G., D.V., J.B., E.A.S.-G., C.G.B.-J., S.A.T., M.W.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0002-0827-9611
Darlene VeruttipongDivision of Primary Care and Population Health, Department of Medicine (S.M.R.K., S.V., D.W.G., D.V., J.B., E.A.S.-G., C.G.B.-J., S.A.T., M.W.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0002-8636-5267
Juliana BarattaDivision of Primary Care and Population Health, Department of Medicine (S.M.R.K., S.V., D.W.G., D.V., J.B., E.A.S.-G., C.G.B.-J., S.A.T., M.W.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0003-4630-0239
Erika A Saliba-GustafssonDivision of Primary Care and Population Health, Department of Medicine (S.M.R.K., S.V., D.W.G., D.V., J.B., E.A.S.-G., C.G.B.-J., S.A.T., M.W.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0003-1587-9591
Eleanor LevinDivision of Cardiovascular Medicine, Department of Medicine (N.M.K., E.L.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0001-9405-6301
Cindie GasparAmbulatory Quality and Population Health, Stanford Health Care, Palo Alto, CA (C.G.).ORCID 0000-0002-2637-3767
Cati G Brown-JohnsonDivision of Primary Care and Population Health, Department of Medicine (S.M.R.K., S.V., D.W.G., D.V., J.B., E.A.S.-G., C.G.B.-J., S.A.T., M.W.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0002-5415-3665
Sandra A TsaiDivision of Primary Care and Population Health, Department of Medicine (S.M.R.K., S.V., D.W.G., D.V., J.B., E.A.S.-G., C.G.B.-J., S.A.T., M.W.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0002-8257-8177
Marcy WingetDivision of Primary Care and Population Health, Department of Medicine (S.M.R.K., S.V., D.W.G., D.V., J.B., E.A.S.-G., C.G.B.-J., S.A.T., M.W.), Stanford University School of Medicine, Stanford, CA.ORCID 0000-0002-5893-280X

Funding

Stanford Health Services Research Training ProgramT32HS026128 · AHRQ · STANFORD UNIVERSITY · PI BAKER, LAURENCE C, OWENS, DOUGLAS K · 2018 to 2024
$3.6M
AHRQ HHS T32 HS026128
6 · The paper itself

Abstract

backgroundA limited transthoracic echocardiogram (TTE) can be an appropriate, lower-cost substitute for a full TTE. We assessed the impact of an electronic health record alternative alert promoting the adoption of limited TTEs on the ordering practices of cardiology clinicians and primary care providers and captured their perspectives on the initiative.

methodsThe alert was deployed in a cardiology clinic and 4 primary care clinics at an academic medical center. The alert provided clinical guidance on the appropriate use of limited TTEs when a clinician selected a full TTE order. We used logistic regression to estimate the change in the proportion of limited versus full TTEs ordered between the baseline and intervention periods in clinics with and without the alert. We also conducted interviews with 24 clinicians (5 cardiologists and 19 primary care providers) to identify implementation barriers and facilitators.

resultsCardiology clinicians ordered 10 654 and 3761 TTEs during the baseline and intervention periods, respectively, for 9100 patients. Primary care providers ordered 723 and 617 TTEs during the baseline and intervention periods for 1273 patients. The model estimated that the percentage of limited TTEs ordered increased by 16.1±2.3 percentage points (

conclusionsAn alternative alert providing clinical guidance on the use of limited TTEs at the point of care increased the selection of this lower-cost test in cardiology and primary care clinics. Perspectives on the alert differed between specialists and nonspecialists, highlighting the importance of tailoring intervention design to clinical expertise.

Indexed as

CardiologistsEchocardiographyElectronic Health RecordsPractice Patterns, Physicians'Primary Health CareAcademic Medical CentersAgedAttitude of Health PersonnelCardiologyFemaleHeart DiseasesHumansMaleMiddle AgedPredictive Value of TestsReminder Systemscardiologyechocardiographyimplementation sciencepoint-of-care systemsprimary health carequalitative researchquality improvement

Identifiers

PMID39561232
PMCPMC11581681

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.