Translating Evidence-Based Guidelines Into Clinical Decision Support Tools to Improve Identification and Management of Familial Hypercholesterolemia

Abstract

Evidence-based clinical guidelines serve to support clinical decision making, but implementing such guidelines into practice remains a challenge. Familial hypercholesterolemia (FH) is a high impact clinical condition that exemplifies this disconnect. Using implementation science methods, we designed clinical decision support tools embedded into the electronic health record, including a FH-focused electronic health record Smart Set and clinic note template, to improve the care of adult and pediatric patients at high-risk of FH. End-user feedback gathered through direct observations, semi-structured interviews, and deliberative engagement sessions was used to inform the development of the tools before and after pilot-testing. Clinicians desired comprehensive, guidelines-based tools that promoted collaborative care. During pilot testing, end-users provided insights into technical issues encountered with the tool's first iteration and suggested regular check-in sessions to monitor issues moving forward. This methodology can be used to surmount challenges that prevent the uptake of evidence-based guidelines into practice.

Figure 1.

Prototype of FH-specific Smart Set (top row) and note template (bottom row) for adult patients. The Dutch Lipid Clinic Network calculator is only included for the adult version of these tools.