Interacting with best practice advisory (BPA) notifications in the electronic medical record significantly improves screening rates for abdominal aortic aneurysms

Abstract

Objective

Best practice advisory notifications (BPAs) have become an integral part of many electronic medical record (EMR) systems. These communications alert providers to recommended therapy or screenings for patients depending on factors found within the EMR. Our goal was to evaluate the impact of BPAs on the rate of abdominal aortic aneurysm (AAA) screening in patients who met guidelines for screening in a single-center EMR.

Methods

We reviewed all patients who triggered a BPA alert for AAA screening from December 2018 to December 2021 in a single tertiary academic setting. The BPA alerts the provider when closing the chart when a patient meets the criteria for AAA screening based on the United States Preventive Services Task Force recommendations of screening male patients aged 65 to 75 years with a smoking history. Provider responses to these triggers were analyzed, and the predictors of response to the advisory and its impact on AAA screening for individual patients within 6 months of the alert was evaluated.

Results

Over this period, 1292 patients triggered the BPA for AAA screening. After excluding deceased patients, 1205 patients were included in the final analysis. Providers interacted with rather than dismissed the BPA in 20.4% of patients. The overall screening rate in this patient cohort was 28.28%. Interacting with the BPA significantly increased the odds of being appropriately screened for a AAA (odds ratio, 2.48). A higher number of visits and BPA triggers correlated with increased odds of undergoing screening for AAA (odds ratios, 1.08 and 1.02, respectively). Additionally, patients who underwent screening were younger in age and more often African American as compared with other races. The presence and number of comorbid conditions were not associated with screening rates, although hyperlipidemia was associated with positive response to BPA.

Conclusions

The overall rate of appropriate AAA screening is low, despite the presence of BPAs. Positively interacting with rather than dismissing the BPA is correlated with an increased rate of appropriate AAA screening. Providers were more likely to screen patients if the patient was younger, had more health care system visits, or if the trigger was delivered more often to members of the health care team. Further study is needed to evaluate provider factors that will result in an increased adherence to recommended screening guidelines.