We plan to develop decision support interventions in three clinical areas: coronary artery disease, diabetes mellitus and prevention. Since submitting our proposal, we have chosen and begun to develop specific guidelines within these disease areas: anti-platelet therapy for coronary artery disease, glycemic control and prevention of complications in diabetes and hypertension screening for our prevention guideline.
In order to more clearly express the scope of our knowledge modeling exercise, we have also attached several draft disambiguated knowledge specifications we are preparing.
In future years, we plan to develop decision support interventions in other clinical areas.
Coronary Artery Disease (CAD)
Rule source: U.S. Preventive Services Task Force recommendation on Aspirin for the Primary Prevention of Cardiovascular Events and the American College of Cardiology’s guideline on Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease.
Scope: Patients with diabetes OR coronary artery disease.
Summary: Clinicians of patients with either diabetes or coronary artery disease who have indications to be on an anti-platelet but are not currently prescribed an anti-platelet are advised to start either aspirin or clopidogrel.
Diabetes Mellitus
Rule source: 2007 Diabetes Management Standards of Care from the Clinical Practice Recommendations of the American Diabetes Association, as augmented by Partners HealthCare.
NB: The knowledge specifications for coronary artery disease and hypertension are derived directly from the source guidelines. For diabetes mellitus, we have closely followed the guidelines from the American Diabetes Association, but where there was ambiguity or uncertainty in the guidelines, we have augmented them with the assistance of a local diabetes expert committee under the supervision of Dr. David Nathan, an internationally recognized expert on diabetes management.
Scope: Patients with type 2 diabetes
Summary: Defines conditions for clinician and patient reminders for hemoglobin A1c checks, ophthalmologic exams, foot exams, and urine protein screening. Defines conditions for advising when to start or adjust diabetic medications, including angiotensin-converting enzymeinhibitors and angiotensin receptor blockers.
USPSTF Guideline
Rule source: U.S. Preventive Services Task Force recommendations on Screening for High Blood Pressure
Scope: Patients with either diabetes OR coronary artery disease.
Summary: Defines conditions for clinician and patient reminders to monitor/record blood pressure measurements and for suggesting referrals to nutrition, cardiac rehab, and hypertension specialists
