基层医疗诊所中行为健康筛查临床决策支持工具的开发与应用。
Development and use of a clinical decision support tool for behavioral health screening in primary care clinics.
作者信息
Burdick Timothy E, Kessler Rodger S
机构信息
Timothy E. Burdick MD MSc, Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, HB 7250, Hanover, NH 03755, Email:
出版信息
Appl Clin Inform. 2017 Apr 26;8(2):412-429. doi: 10.4338/ACI-2016-04-RA-0068.
OBJECTIVE
Screening, brief intervention, and referral for treatment (SBIRT) for behavioral health (BH) is a key clinical process. SBIRT tools in electronic health records (EHR) are infrequent and rarely studied. Our goals were 1) to design and implement SBIRT using clinical decision support (CDS) in a commercial EHR; and 2) to conduct a pragmatic evaluation of the impact of the tools on clinical outcomes.
METHODS
A multidisciplinary team designed SBIRT workflows and CDS tools. We analyzed the outcomes using a retrospective descriptive convenience cohort with age-matched comparison group. Data extracted from the EHR were evaluated using descriptive statistics.
RESULTS
There were 2 outcomes studied: 1) development and use of new BH screening tools and workflows; and 2) the results of use of those tools by a convenience sample of 866 encounters. The EHR tools developed included a flowsheet for documenting screens for 3 domains (depression, alcohol use, and prescription misuse); and 5 alerts with clinical recommendations based on screening; and reminders for annual screening. Positive screen rate was 21% (≥1 domain) with 60% of those positive for depression. Screening was rarely positive in 2 domains (11%), and never positive in 3 domains. Positive and negative screens led to higher rates of documentation of brief intervention (BI) compared with a matched sample who did not receive screening, including changes in psychotropic medications, updated BH terms on the problem list, or referral for BH intervention. Clinical process outcomes changed even when screening was negative.
CONCLUSIONS
Modified workflows for BH screening and CDS tools with clinical recommendations can be deployed in the EHR. Using SBIRT tools changed clinical process metrics even when screening was negative, perhaps due to conversations about BH not captured in the screening flowsheet. Although there are limitations to the study, results support ongoing investigation.
目的
行为健康（BH）的筛查、简短干预及转介治疗（SBIRT）是一项关键的临床流程。电子健康记录（EHR）中的SBIRT工具并不常见，且很少被研究。我们的目标是：1）在商业EHR中利用临床决策支持（CDS）设计并实施SBIRT；2）对这些工具对临床结果的影响进行务实评估。
方法
一个多学科团队设计了SBIRT工作流程和CDS工具。我们使用一个年龄匹配的对照便利样本进行回顾性描述性队列分析来评估结果。从EHR中提取的数据使用描述性统计进行评估。
结果
研究了两个结果：1）新的BH筛查工具和工作流程的开发与使用；2）866次就诊便利样本使用这些工具的结果。开发的EHR工具包括一个用于记录三个领域（抑郁、酒精使用和处方药物滥用）筛查情况的流程图；5条基于筛查的带有临床建议的警报；以及年度筛查提醒。阳性筛查率为21%（≥1个领域），其中60%为抑郁阳性。在两个领域筛查很少呈阳性（11%），在三个领域从未呈阳性。与未接受筛查的匹配样本相比，阳性和阴性筛查导致简短干预（BI）记录率更高，包括精神药物的变化、问题列表上BH术语的更新或BH干预的转介。即使筛查为阴性，临床过程结果也会改变。
结论
用于BH筛查的改良工作流程和带有临床建议的CDS工具可部署在EHR中。使用SBIRT工具即使筛查为阴性也会改变临床过程指标，这可能是由于筛查流程图中未记录的关于BH的对话。尽管该研究存在局限性，但结果支持持续调查。
Zotero 插件