Clinical Decision Support System Helps Address Health Inequities in Cardiology Admissions

After documenting evidence of inequities in hospital admissions for patients presenting in the Emergency Department with heart failure, researchers at Brigham and Women’s Hospital (BWH), a founding member of the Mass General Brigham healthcare system, developed a framework and intervention that offers a feasible solution for addressing and reducing inequities and delivering appropriate care for all patients with heart failure. The intervention, known as a Clinical Decision Support System (CDSS), uses a best practice advisory message that displays on a patient's electronic medical record reminding providers of inequitable access and suggesting admission to cardiology if other clinical indications for general medicine service are not present. The CDSS intervention’s implementation is described in a paper published in NEJM Catalyst.

In a previous analysis, the research team studied data from September 2008 to November 2017. They found that 66.6% of white patients (874 of 1,312), 53.1% of Black patients (247 of 465), and 52.6% (100 of 190) of Latino patients were admitted to cardiology.

Over the course of two years, the CDSS message was displayed 210 times, or the equivalent of 1.38 times per week. In more than half of cases (59.6%), after receiving the CDSS message, physicians redirected Black and Latino patients originally assigned to GMS to cardiology, while 40.5% stayed with GMS. This equates to 125 patients total, or, on average, 0.81 patients per week of the study.

“In just over two years, utilization of the CDSS achieved quantitative redress of the documented 10 years of inequity in access by redirecting 125 Black or Latino patients to cardiology service,” said lead author Bram Wispelwey, MD, MS, MPH, of the Division of General and Internal Medicine at BWH.

The authors note that 13 patients redirected from GMS to cardiology accepted transfer to a community hospital with cardiology consultation. There were no indications that their care was negatively impacted by a transfer to a community hospital.

Authorship: In addition to Wispelwey, authors include Michelle E. Morse, Zeyu Li, Cassandra Georges, Lauren A. Eberly, Artair Rogers, Michael Wilson, Erin McElrath, Jonathan McCabe, Paul C. Chen, and Regan H. Marsh.

Disclosures: None.

Funding: The project was supported by three sources of internal funding at Brigham and Women’s Hospital: 1) The Department of Medicine Health Equity Innovation Pilot; 2) The President’s Fund; 3) The H. Richard Nesson Fellowship.

Paper cited: Wispelwey B et al. “A Healing ARC for Institutional Trustworthiness: Evaluating a Clinical Decision Support System to Redress Racial Inequities” NEJM Catalyst DOI: 10.1056/CAT.25.0104