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Leveraging the Electronic Medical Record to Implement an Abdominal Aortic Aneurysm Screening Program
Study Questions:
What is the impact of a screening program for abdominal aortic aneurysm (AAA) implemented through an electronic medical record (EMR)?
Methods:
The intervention targeted male patients between the ages of 65 and 75 years, with any history of current or past smoking. Through the use of a best practice alert (BPA) integrated into an EMR between March 2012 and June 2013, office staff and providers were prompted to order an aortic ultrasound. Eligible patients had no record of an abdominal imaging study in the past 10 years. Patients with first-detected AAAs were triaged for follow-up with a primary care physician or a vascular surgeon.
Results:
During 15 months of the study, there was a decrease in unscreened and eligible patients from 51.74% to 20.26%. The yield of the screening program was 1.3%; only 0.3% of newly identified AAAs were >4.0 cm. Costs of additional imaging and administrative overhead have been estimated at about $3 million.
Conclusions:
In a large integrated health care organization, a BPA implemented through an EMR can improve screening for AAA.
Perspective:
This is an important study that draws attention to the success of a BPA in improving screening for AAA. Such screening, while recommended in men ages 65-75 years of age with any history of smoking, is sometimes overlooked (even though Medicare covers a one-time screening ultrasound for new eligible male enrollees). The EMR is a tool that can clearly improve screening when it is inadvertently overlooked. It would be important to characterize the impact of such screening on morbidity and mortality from AAA. The overall yield of the intervention was low, and the benefit of such screening will need to be framed in the context of incremental cost.
Keywords: Follow-Up Studies, Physicians, Primary Care, Medicare, Aortic Aneurysm, Abdominal, Smoking
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