This project was an administrative supplement to R01HL133793 (CV Wizard: Did a Prioritized, Point-of-Care Clinical Decision Support Tool Improve Guideline-Based CVD Risk Factor Control in Safety Net Clinics?). The NOT-MH-20-053 researched the pandemic’s secondary health effects in populations impacted by health disparities and disruptions in care provision, and the role of digital health interventions in risk management. This work addressed those priorities. It also strengthened the parent grant’s responsiveness to PAR 15-279 (its funding mechanism) by addressing guideline-to-practice gaps in high-risk populations and identifying uses of technology for patient engagement.

This supplement to the parent grant was requested in response to the unanticipated COVID-19 pandemic and its impact on primary care delivery nationwide, including in the study clinics. Many providers shifted to virtual care (VC; i.e., telephone and video encounters) because of the pandemic: in the parent study’s clinics, rates of VC rose from <1% to >52% of all encounters between March and June 2020. Thus, research was needed on how the shift to VC affected cardiovascular disease (CVD) risk management, the shift’s impact on existing health disparities in vulnerable populations, and whether CVD care in VC could be enhanced by the use of patient-centered clinical decision support (CDS) tools. As the parent study was collecting longitudinal data on CVD risk management and the role of CDS in community health center (CHC) patients, it was poised to conduct research that addressed these knowledge gaps by studying CVD care quality and outcomes, and the role of patient-centered CDS in the VC context.

The parent study was a trial of the uptake and impact of CV Wizard©, a CDS tool designed to support point-of-care, patient-engaged CVD risk management in the CHC setting. CV Wizard provided an individualized, prioritized summary of a given patient’s reversible CVD risk, in the form of a low-literacy ‘patient view’ and a ‘provider view’ with care suggestions based on current national guidelines. Study activities took place as planned before the pandemic’s onset, including recruiting and randomizing 70 CHCs to staggered implementation of CV Wizard, implementing it in Arm 1 clinics, and completing data collection for Aim 1 analyses of the tool’s impact on CVD outcomes. CV Wizard’s implementation in Arm 2 clinics was delayed by five months due to the pandemic. In response to the pandemic-driven shift to VC, the CV Wizard tool and its training materials were adapted to enable its use in VC. This adaptation was part of the tool’s implementation in Arm 2 clinics, which began in mid-September 2020, and Arm 1 clinics were trained to use the tool in VC in August 2020. Preliminary results from Aim 1 analyses, underway as scheduled (involving data from before COVID-19), showed an association between the use of CV Wizard and significantly improved blood pressure control.

This project influenced the current grant’s design and methods in the following ways. Aims 2-3 of the parent study involved understanding and addressing barriers to CV Wizard’s adoption and impact in the context of point-of-care encounters. This supplement augmented these Aims by assessing CVD prevention and the role of patient-facing CDS in the VC context. In brief, the work extended the parent study by adding data collection and analyses that augmented those planned and underway in the parent study. This involved: 1) quantitative analyses of CVD risk management and outcomes when care was provided in VC versus in-person encounters, and whether patient-centered CDS moderated this relationship; and 2) mixed-methods analyses of patient and provider perceptions of CVD care in VC, and the use of CV Wizard in VC.

Specifically, the analyses augmented the parent study's Aim 2 by assessing how the shift to VC impacted CVD risk management in high-risk CHC patients, and Aim 3 by assessing how CV Wizard was used to support care quality and patient engagement in the VC context. These analyses increased the influence and utility of the parent study’s results. Further, as the parent study was designed to assess CV Wizard’s adoption and impact on CVD risk management, the supplemental work was essential to this assessment given the unanticipated shift to VC.