Abughali Nazha, Maxwell Jessie R, Kamath Aparna S, Nwankwo Uchebike, Mhanna Maroun J
From the *Department of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH; ‡University of New Mexico Hospital, Albuquerque, NM; ‡ Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; and §Mercy Health Physician Partners, Grand Rapids, MI.
Pediatr Infect Dis J. 2014 Apr;33(4):376-80. doi: 10.1097/INF.0000000000000129.
The American Academy of Pediatrics recommends hepatitis C virus (HCV) antibody testing for all HCV- exposed infants at age ≥ 18 months. However, many of these infants are not appropriately tested. In 2006, the pediatric infectious disease service (PIDS) at our institution implemented interventions using electronic medical records (EMR) to improve appropriate HCV testing for HCV-exposed infants.
Two-part study: During the first period (January 1, 1993, to December 31, 2005), medical records of all infants born to mothers with HCV were retrospectively reviewed for patient's demographics and infant's HCV testing. PIDS interventions included contacting the primary care physician through EMR requesting HCV testing for children without proper testing. During the second period (January 1, 2006, to December 31, 2011), interventions using EMR were implemented prospectively, including PIDS consultations during birth hospitalization for all HCV-exposed infants, addition of HCV exposure to the EMR problem list and communication with PCPs via the EMR to assure appropriate HCV testing.
About 67,112 infants were born during the study period; 280 had maternal HCV infection and 193 continued to receive medical care at our institution. PIDS interventions using EMR resulted in a significant improvement of appropriate HCV testing among HCV-exposed infants from 8% (10/121) to 50% (36/72); P <0.0001. It also resulted in the identification of 5 new HCV-infected children; 3 of them were born before 2006 and previously undiagnosed.
Interventions using EMR improved the identification and appropriate HCV follow up of infants born to HCV-infected mothers.
美国儿科学会建议对所有年龄≥18个月且暴露于丙型肝炎病毒（HCV）的婴儿进行HCV抗体检测。然而，许多此类婴儿未得到适当检测。2006年，我们机构的儿科传染病服务部门（PIDS）实施了利用电子病历（EMR）的干预措施，以改善对暴露于HCV的婴儿进行适当的HCV检测。
分为两个阶段的研究：在第一阶段（1993年1月1日至2005年12月31日），对所有HCV感染母亲所生婴儿的病历进行回顾性审查，以了解患者人口统计学信息和婴儿的HCV检测情况。PIDS的干预措施包括通过EMR联系初级保健医生，要求对未进行适当检测的儿童进行HCV检测。在第二阶段（2006年1月1日至2011年12月31日），前瞻性地实施了利用EMR的干预措施，包括在所有暴露于HCV的婴儿出生住院期间进行PIDS咨询，在EMR问题列表中添加HCV暴露信息，并通过EMR与初级保健医生沟通，以确保进行适当的HCV检测。
在研究期间约有67112名婴儿出生；280名母亲感染HCV，193名婴儿继续在我们机构接受医疗护理。利用EMR的PIDS干预措施使暴露于HCV的婴儿中适当的HCV检测率从8%（10/121）显著提高到50%（36/72）；P<0.0001。这也导致发现了5名新的HCV感染儿童；其中3名在2006年之前出生且此前未被诊断。
利用EMR的干预措施改善了对HCV感染母亲所生婴儿的识别以及适当的HCV随访。
