Reducing Excess Cardiovascular Risk in People with Serious Mental Illness

Project Name:
Reducing Excess Cardiovascular Risk in People with Serious Mental Illness
Principal Investigator:
Rebecca Rossom, MD, MS
Principal Investigator Contact Information:
Rebecca.C.Rossom@HealthPartners.com
Principal Investigator institution:
HealthPartners, Minneapolis, MN
Funder
NIMH
Funding Period:
08/2014 – 06/2019[RR1] 
Abstract:
People with serious mental illness (SMI) (schizophrenia, schizoaffective disorder, bipolar disorder) die, on average, 20 years earlier than their peers. Cardiovascular (CV) disease is the predominant cause.  Primary care clinicians are often unaware of increased risk in patients with SMI and, even when they do identify elevated CV risk factors, often do not take appropriate clinical actions. Electronic health record-based clinical decision support can identify at-risk patients with SMI and systematically prompt more effective treatment of their CV risk factors, but its potential has been largely untapped. 
Grant Number:
U19MH092201
Participating Sites:
HealthPartners, Minneapolis, MN (Lead Site)
Essential Health, Duluth, MN
Park Nicollet, Minneapolis, MN
Investigators:
Rebecca Rossom, MD, MS     
Steve Waring, PhD
Patrick O’Connor, MD, MS, MA
JoAnn Sperl-Hillen, MD
Lauren Crain, PhD
Kris Kopski, MD
Stephanie Hooker, PhD
Goals:
The objectives of this project were to improve CV risk factor care in patients with SMI through a pragmatic trial of a point-of-care electronic health record-based clinical decision support system (referred to as “CV Wizard”).  The trial was conducted in over 80 primary care clinics in three large healthcare systems.
Description of study sample:
Patients enrolled in the study were ages 18-75 with diagnoses of schizophrenia, schizoaffective disorder or bipolar disorder (i.e. serious mental illness (SMI)) and were not at goal for at least one of the following reversible cardiovascular risk factors: BMI, tobacco use, LDL, blood pressure, A1c or aspirin use.
Current Status:
The project was implemented in all 3 sites and completed patient enrollment in September 2018.   A total of 11,046 patients with SMI made at least one primary care visit during the study period, and 8937 patients made at least 2 primary care visits.
Study Registration:
ClinicalTrials.gov # NCT02451670
Publications:
Rossom RC, O’Connor PJ, Crain AL, Waring S, Ohnsorg K, Taran A, Kopski K, Sperl-Hillen JM. Pragmatic trial design of an intervention to reduce cardiovascular risk in people with serious mental illness. Contemp Clin Trials. 2020 Feb 20;91:105964. doi: 10.1016/j.cct.2020.105964. PubMed PMID: 32087336. Sperl-Hillen JM, Rossom RC, Kharbanda EO, Gold R, Geissal ED, Elliott TE, Desai JR, Rindal DB, Saman DM, Waring SC, Margolis KL, O’Connor PJ. Priorities Wizard: Multisite Web-Based Primary Care Clinical Decision Support Improved Chronic Care Outcomes with High Use Rates and High Clinician Satisfaction Rates. EGEMS (Wash DC). 2019 Apr 3;7(1):9. doi: 10.5334/egems.284. Review. PubMed PMID: 30972358; PubMed Central PMCID: PMC6450247.
Resources:
N/A
Lessons Learned:
N/A
What’s next?
Analyses and manuscript development are in progress.