Effect of visit length and a clinical decision support tool on abdominal aortic aneurysm screening rates in a primary care practice

RATIONALE, AIMS AND OBJECTIVES In 2005, the US Preventive Services Task Force issued recommendations for one-time abdominal aortic aneurysm (AAA) screening using abdominal ultrasonography in men aged 65 to 75 years with a history of smoking. However, despite a mortality rate of up to 80% for ruptured AAAs, providers order the screening for a minority of patients. We examined AAA screening rates among providers and investigated the role of visit duration and other factors in whether patients received screening. We also looked for potential interventions to improve compliance. METHODS We retrospectively reviewed the records of patients who visited our clinic over a 4-month period and met the US Preventive Services Task Force criteria for AAA screening when our practice had a real-time decision support tool implemented to identify patients due for the screening. We also surveyed our clinic's providers about their knowledge and attitudes regarding AAA screening. RESULTS Despite the use of physician reminders, providers ordered screening for only 12.9% of eligible patients. Screening was more likely to be ordered during longer visits versus shorter ones (24% vs. 6%). When surveyed, most providers (70.6%) indicated that a nurse-directed ordering system would improve compliance. CONCLUSIONS This study illustrates that physician reminders alone are not sufficient to improve care and that more time is needed for preventive services. This provides additional support for the use of a multidisciplinary approach to preventive screening, as in a patient-centred medical home. In a patient-centred medical home, a care team of physicians, nurses and office staff use technology such as clinical decision support to provide comprehensive, coordinated patient care.