User-Centered Design Approach to Dynamic Clinical Decision Support in Primary Prevention of Cardiovascular Disease

Background/Objectives: National guidelines include recommendations for cardiovascular disease (CVD) prevention, but gaps in prevention still exist. Clinical decision support (CDS) tools may be an avenue for delivering preventive care. The goal of this project was to understand how clinicians approach primary prevention of CVD and to determine barriers and facilitators in delivery of primary preventive care with and beyond a CDS tool. Methods: A user-centered design approach including a cross-sectional survey and qualitative interviews was deployed in a health system in Central and Northern California. Clinician responses to the survey in addition to clinician interviews about perspectives on CVD were analyzed. Results: A total of 62 primary care physicians, advanced practice clinicians, and nurse practitioners completed surveys, and 7 primary care clinicians participated in interviews. Primary care clinicians generally agree that preventive care would be more efficient with team-based care. Physician-centered care and CVD preventive care were constricted by limited time, the highly varied nature of primary care, and a lack of standardized and personalized CDS tools. Once patients at risk of CVD are identified, there is also a lack of clarity around resources available to support downstream care for patients. Conclusions: The results highlight the challenges in providing CVD prevention for primary care clinicians. A team-based approach, supported by digital CDS tools, can be more effective for ensuring the necessary CVD prevention communication and coordination takes place.