Murphy Daniel R, Meyer Ashley N D, Vaghani Viralkumar, Russo Elise, Sittig Dean F, Richards Kyle A, Wei Li, Wu Louis, Singh Hardeep
Daniel R. Murphy, MD MBA, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), Houston Center for Innovations in Quality, Effectiveness & Safety (IQuESt) (152), 2002 Holcombe Boulevard, Houston, TX 77030 USA, 713-440-4600 (o), 713-748-7359 (f), Email:
Appl Clin Inform. 2017 Mar 22;8(1):279-290. doi: 10.4338/ACI-2016-10-RA-0176.
Strategies to ensure timely diagnostic evaluation of hematuria are needed to reduce delays in bladder cancer diagnosis.
To evaluate the performance of electronic trigger algorithms to detect delays in hematuria follow-up.
We developed a computerized trigger to detect delayed follow-up action on a urinalysis result with high-grade hematuria (>50 red blood cells/high powered field). The trigger scanned clinical data within a Department of Veterans Affairs (VA) national data repository to identify all patient records with hematuria, then excluded those where follow-up was unnecessary (e.g., terminal illness) or where typical follow-up action was detected (e.g., cystoscopy). We manually reviewed a randomly-selected sample of flagged records to confirm delays. We performed a similar analysis of records with hematuria that were marked as not delayed (non-triggered). We used review findings to calculate trigger performance.
Of 310,331 patients seen between 1/1/2012-12/31/2014, the trigger identified 5,857 patients who experienced high-grade hematuria, of which 495 experienced a delay. On manual review of 400 randomly-selected triggered records and 100 non-triggered records, the trigger achieved positive and negative predictive values of 58% and 97%, respectively.
Triggers offer a promising method to detect delays in care of patients with high-grade hematuria and warrant further evaluation in clinical practice as a means to reduce delays in bladder cancer diagnosis.
需要采取策略确保对血尿进行及时的诊断评估，以减少膀胱癌诊断的延误。
评估电子触发算法检测血尿后续跟进延误情况的性能。
我们开发了一种计算机化触发器，用于检测对伴有重度血尿（>50个红细胞/高倍视野）的尿液分析结果的后续跟进延迟情况。该触发器扫描了退伍军人事务部（VA）国家数据存储库中的临床数据，以识别所有有血尿的患者记录，然后排除那些无需后续跟进的情况（如终末期疾病）或已检测到典型后续跟进措施的情况（如膀胱镜检查）。我们手动审查了随机抽取的标记记录样本，以确认是否存在延误。我们对标记为无延误（未触发）的血尿记录进行了类似分析。我们利用审查结果来计算触发器的性能。
在2012年1月1日至2014年12月31日期间就诊的310331名患者中，该触发器识别出5857名出现重度血尿的患者，其中495名出现了延误。在对400份随机抽取的触发记录和100份未触发记录进行人工审查时，该触发器的阳性预测值和阴性预测值分别为58%和97%。
触发器为检测重度血尿患者护理中的延误提供了一种有前景的方法，作为减少膀胱癌诊断延误的手段，值得在临床实践中进一步评估。
