Murphy Daniel R, Wu Louis, Thomas Eric J, Forjuoh Samuel N, Meyer Ashley N D, Singh Hardeep
Daniel R. Murphy, Louis Wu, Ashley N.D. Meyer, and Hardeep Singh, Houston Veterans Affairs Health Services Research and Development, Michael E. DeBakey Veterans Affairs Medical Center, and Section of Health Services Research, Baylor College of Medicine; Eric J. Thomas, University of Texas Houston Medical School and University of Texas Houston-Memorial Hermann Center for Healthcare Quality and Safety, Houston; and Samuel N. Forjuoh, Scott and White Healthcare, Texas A&M Health Science Center, College of Medicine, Temple, TX.
J Clin Oncol. 2015 Nov 1;33(31):3560-7. doi: 10.1200/JCO.2015.61.1301. Epub 2015 Aug 24.
We tested whether prospective use of electronic health record-based trigger algorithms to identify patients at risk of diagnostic delays could prevent delays in diagnostic evaluation for cancer.
We performed a cluster randomized controlled trial of primary care providers (PCPs) at two sites to test whether triggers that prospectively identify patients with potential delays in diagnostic evaluation for lung, colorectal, or prostate cancer can reduce time to follow-up diagnostic evaluation. Intervention steps included queries of the electronic health record repository for patients with abnormal findings and lack of associated follow-up actions, manual review of triggered records, and communication of this information to PCPs via secure e-mail and, if needed, phone calls to ensure message receipt. We compared times to diagnostic evaluation and proportions of patients followed up between intervention and control cohorts based on final review at 7 months.
We recruited 72 PCPs (36 in the intervention group and 36 in the control group) and applied the trigger to all patients under their care from April 20, 2011, to July 19, 2012. Of 10,673 patients with abnormal findings, the trigger flagged 1,256 patients (11.8%) as high risk for delayed diagnostic evaluation. Times to diagnostic evaluation were significantly lower in intervention patients compared with control patients flagged by the colorectal trigger (median, 104 v 200 days, respectively; n = 557; P < .001) and prostate trigger (40% received evaluation at 144 v 192 days, respectively; n = 157; P < .001) but not the lung trigger (median, 65 v 93 days, respectively; n = 19; P = .59). More intervention patients than control patients received diagnostic evaluation by final review (73.4% v 52.2%, respectively; relative risk, 1.41; 95% CI, 1.25 to 1.58).
Electronic trigger-based interventions seem to be effective in reducing time to diagnostic evaluation of colorectal and prostate cancer as well as improving the proportion of patients who receive follow-up. Similar interventions could improve timeliness of diagnosis of other serious conditions.
我们测试了前瞻性地使用基于电子健康记录的触发算法来识别有诊断延迟风险的患者，是否能够预防癌症诊断评估的延迟。
我们在两个地点对初级保健提供者（PCP）进行了一项整群随机对照试验，以测试前瞻性地识别肺癌、结直肠癌或前列腺癌诊断评估可能延迟的患者的触发因素，是否能够缩短后续诊断评估的时间。干预步骤包括查询电子健康记录库中存在异常发现且缺乏相关后续行动的患者，人工审查触发的记录，并通过安全电子邮件将此信息传达给PCP，如有需要，还会打电话以确保收到信息。我们根据7个月时的最终审查，比较了干预组和对照组之间的诊断评估时间以及接受随访的患者比例。
我们招募了72名PCP（干预组36名，对照组36名），并在2011年4月20日至2012年7月19日期间，将触发因素应用于他们所照顾的所有患者。在10673名有异常发现的患者中，触发因素将1256名患者（11.8%）标记为诊断评估延迟的高风险患者。与结直肠癌触发因素标记的对照组患者相比，干预组患者的诊断评估时间显著缩短（中位数分别为104天和200天；n = 557；P <.001），与前列腺癌触发因素标记的对照组患者相比也显著缩短（分别有40%的患者在144天和192天接受评估；n = 157；P <.001），但与肺癌触发因素标记的对照组患者相比无显著差异（中位数分别为65天和93天；n = 19；P =.59）。通过最终审查，接受诊断评估的干预组患者多于对照组患者（分别为73.4%和52.2%；相对风险，1.41；95% CI，1.25至1.58）。
基于电子触发因素的干预措施似乎在缩短结直肠癌和前列腺癌的诊断评估时间以及提高接受随访的患者比例方面有效。类似的干预措施可能会提高其他严重疾病的诊断及时性。
