Clinician use of the Statin Choice Shared Decision-making Encounter Tool in a Major Health System

Background Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice. Objective To describe real-world use of an SDM encounter tool for statin prescribing, Statin Choice, embedded into the workflow of an electronic health record. Design Cross-sectional study. Participants Clinicians and their statin-eligible patients who had outpatient encounters between January 2020 and June 2021 in Cleveland Clinic Health System. Main Measures Clinician use of Statin Choice was recorded within the Epic record system. We categorized each patient’s 10-year atherosclerotic cardiovascular disease risk into low (< 5%), borderline (5–7.5%), intermediate (7.5–20%), and high (≥ 20%). Other patient factors included age, sex, insurance, and race. We used mixed effects logistic regression to assess the odds of using Statin Choice for statin-eligible patients, accounting for clustering by clinician and site. We generated a residual intraclass correlation coefficient (ICC) to characterize the impact of the clinician on Statin Choice use. Key Results Statin Choice was used in 7% of 68,505 eligible patients. Of 1047 clinicians, 48% used Statin Choice with ≥ 1 patient, and these clinicians used it with a median 9% of their patients (interquartile range: 3–22%). In the mixed effects logistic regression model, patient age (adjusted OR per year: 1.04; 95%CI 1.03–1.04) and 10-year ASVCD risk (aOR for 5–7.5% versus < 5% risk: 1.28; 95%CI: 1.14–1.44) were associated with use of Statin Choice. Black versus White race was associated with a lower odds of Statin Choice use (aOR: 0.83; 95%CI: 0.73–0.95), as was female versus male sex (aOR: 0.83; 95%CI: 0.76–0.90). The model ICC demonstrated that 53% of the variation in use of Statin Choice was clinician-driven. Conclusions Patient factors, including race and sex, were associated with clinician use of Statin Choice; half the variation in use was attributable to individual clinicians.