Equity of access to CVD risk management using electronic clinical decision support in the coronary care unit
Received 8 May 2009; received in revised form 16 October 2009; accepted 28 January 2010. published online 19 February 2010. Corrected Proof
Abstract
Background
Cardiovascular (CVD) risk management post myocardial infarction is inconsistently delivered with those who need the most receiving the least — the ‘inverse care law.’ The Acute PREDICT Initiative is a nurse led computerised decision support system (CDSS), to provide point-of-care guideline-based, patient-specific CVD risk management recommendations to all.
Methods
All patients admitted to Middlemore Hospital CCU over 2years with acute CVD-related events potentially ‘eligible’ for PREDICT assessment were identified. Age, gender, ethnicity and a small area measure of socioeconomic status (NZDep01) were assessed.
Results
1813/2246 (81%) of people admitted were eligible for a PREDICT assessment. Of those, 973 (54%) received a complete assessment. There were no important differences by quintile of deprivation or ethnicity between the patients receiving PREDICT and the rest. PREDICT assessments were less likely for the elderly (35.7% of >75years compared with 57.7% of <75years), for women (47.1% of women and 56.5% of men), and for those who had 5 or more previous admissions.
Conclusions
Patients potentially at higher risk because of their ethnic or socioeconomic background received equitable access to in-hospital CVD risk management post MI using PREDICT. However, some other high-risk groups under-utilised the system.
ABSTRACT
years with acute CVD-related events potentially ‘eligible’ for PREDICT assessment were identified. Age, gender, ethnicity and a small area measure of socioeconomic status (NZDep01) were assessed.