通过强制性临床决策支持消除医疗保健差异：以静脉血栓栓塞（VTE）为例。
Eliminating Health Care Disparities With Mandatory Clinical Decision Support: The Venous Thromboembolism (VTE) Example.
作者信息
Lau Brandyn D, Haider Adil H, Streiff Michael B, Lehmann Christoph U, Kraus Peggy S, Hobson Deborah B, Kraenzlin Franca S, Zeidan Amer M, Pronovost Peter J, Haut Elliott R
机构信息
*Department of Surgery, Division of Acute Care Surgery, The Johns Hopkins University School of Medicine †The Armstrong Institute for Patient Safety, Johns Hopkins Medicine ‡Division of Health Sciences Informatics §Department of Anesthesiology & Critical Care Medicine ∥Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), The Johns Hopkins University School of Medicine ¶Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health #Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, MD **Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Vanderbilt University School of Medicine, Nashville, TN ††Department of Pharmacy, The Johns Hopkins Hospital ‡‡Section of Hematology, Department of Internal Medicine, Yale University, New Haven, CT §§Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
出版信息
Med Care. 2015 Jan;53(1):18-24. doi: 10.1097/MLR.0000000000000251.
BACKGROUND
All hospitalized patients should be assessed for venous thromboembolism (VTE) risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacological prophylaxis, and then recommends the risk-appropriate VTE prophylaxis regimen.
OBJECTIVES
The objective of the study was to examine the effect of a quality improvement intervention on race-based and sex-based health care disparities across 2 distinct clinical services.
RESEARCH DESIGN
This was a retrospective cohort study of a quality improvement intervention.
SUBJECTS
The study included 1942 hospitalized medical patients and 1599 hospitalized adult trauma patients.
MEASURES
In this study, the proportion of patients prescribed risk-appropriate, best-practice VTE prophylaxis was evaluated.
RESULTS
Racial disparities existed in prescription of best-practice VTE prophylaxis in the preimplementation period between black and white patients on both the trauma (70.1% vs. 56.6%, P=0.025) and medicine (69.5% vs. 61.7%, P=0.015) services. After implementation of the CCDS tool, compliance improved for all patients, and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5% vs. 85.5%, P=0.99) and medicine (91.8% vs. 88.0%, P=0.082). Similar findings were noted for sex disparities in the trauma cohort.
CONCLUSIONS
Despite the fact that risk-appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and sex, practice varied widely before our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across 2 distinct clinical services. Health information technology approaches to care standardization are effective to eliminate health care disparities.
背景
所有住院患者都应评估静脉血栓栓塞（VTE）风险因素并给予适当的预防措施。为改善所有住院患者的最佳VTE预防措施处方，我们实施了一种强制性计算机化临床决策支持（CCDS）工具。该工具要求完成清单以评估VTE风险因素和药物预防的禁忌症，然后推荐适合风险的VTE预防方案。
目的
本研究的目的是检验一项质量改进干预措施对两项不同临床服务中基于种族和性别的医疗保健差异的影响。
研究设计
这是一项关于质量改进干预措施的回顾性队列研究。
研究对象
该研究纳入了1942名住院内科患者和1599名住院成年创伤患者。
测量指标
在本研究中，评估了接受适合风险的最佳VTE预防措施处方的患者比例。
结果
在实施前阶段，创伤科（70.1%对56.6%，P=0.025）和内科（69.5%对61.7%，P=0.015）服务中，黑人和白人患者在最佳VTE预防措施处方方面存在种族差异。实施CCDS工具后，所有患者的依从性均有所提高，两项服务中黑人和白人患者在最佳预防措施处方方面的差异均被消除：创伤科（84.5%对85.5%，P=0.99）和内科（91.8%对88.0%，P=0.082）。在创伤队列中，性别差异也有类似发现。
结论
尽管无论种族和性别，所有住院患者都应平等地给予适合风险的预防措施，但在我们的质量改进干预之前，实践差异很大。我们的CCDS工具消除了两项不同临床服务中VTE预防措施处方的种族差异。护理标准化的健康信息技术方法有效地消除了医疗保健差异。
Zotero 插件