Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
Ann Emerg Med. 2018 Oct;72(4):438-448. doi: 10.1016/j.annemergmed.2018.05.005. Epub 2018 Jun 22.
We compare the effectiveness of 2 nontargeted HIV and hepatitis C virus screening protocols integrated consecutively into care in an urban emergency department: a nurse-order HIV/hepatitis C virus screening algorithm followed by an automated-laboratory-order HIV/hepatitis C virus screening algorithm programmed into the electronic health record.
This was a before-after comparative effectiveness cohort study. All patients aged 18 to 75 years who received treatment during 5-month periods were eligible for participation. The main outcome measures were the number of patients screened and the number with newly diagnosed HIV and hepatitis C virus infection.
Of the eligible patients, 6,736 (33.9%) completed HIV screening during the automated-laboratory-order HIV/hepatitis C virus screening algorithm, whereas 4,121 (19.6%) completed HIV screening during the nurse-order HIV/hepatitis C virus screening algorithm (difference 14.3%; 95% confidence interval 13.4% to 15.1%); and 6,972 (35.1%) completed hepatitis C virus screening during the automated-laboratory-order HIV/hepatitis C virus screening algorithm, whereas 2,968 (14.2%) completed hepatitis C virus screening during the nurse-order HIV/hepatitis C virus screening algorithm (difference 20.9%; 95% confidence interval 20.1% to 21.7%). More patients had newly diagnosed HIV (23 versus 17) and hepatitis C virus infection (101 versus 29) during the automated-laboratory-order HIV/hepatitis C virus screening algorithm than the nurse-order HIV/hepatitis C virus screening algorithm. Results were more often available before discharge (HIV 87.2% versus 65.1%; hepatitis C virus 90.0% versus 65.4%) and fewer patients underwent repeated screening (HIV 1.6% versus 5.8%; hepatitis C virus 1.3% versus 4.5%) during the automated-laboratory-order HIV/hepatitis C virus screening algorithm than the nurse-order HIV/hepatitis C virus screening algorithm.
An electronic health record algorithm that automatically links HIV/hepatitis C virus screening to laboratory ordering for adult patients is more effective than a nurse-driven protocol. With widespread use of electronic health record systems, this model can be easily replicated and should be considered the standard for future programs.
我们比较了两种非靶向性 HIV 和丙型肝炎病毒筛查方案在城市急诊科连续纳入治疗时的效果：一种是护士主导的 HIV/丙型肝炎病毒筛查算法，另一种是自动实验室主导的 HIV/丙型肝炎病毒筛查算法，该算法已编程到电子健康记录中。
这是一项前后比较的有效性队列研究。所有年龄在 18 至 75 岁之间在 5 个月期间接受治疗的患者均有资格参加。主要结局指标是筛查患者人数和新诊断的 HIV 和丙型肝炎病毒感染人数。
在符合条件的患者中，有 6736 名（33.9%）在自动实验室主导的 HIV/丙型肝炎病毒筛查算法期间完成了 HIV 筛查，而有 4121 名（19.6%）在护士主导的 HIV/丙型肝炎病毒筛查算法期间完成了 HIV 筛查（差异 14.3%；95%置信区间 13.4%至 15.1%）；有 6972 名（35.1%）在自动实验室主导的 HIV/丙型肝炎病毒筛查算法期间完成了丙型肝炎病毒筛查，而有 2968 名（14.2%）在护士主导的 HIV/丙型肝炎病毒筛查算法期间完成了丙型肝炎病毒筛查（差异 20.9%；95%置信区间 20.1%至 21.7%）。在自动实验室主导的 HIV/丙型肝炎病毒筛查算法期间，有更多患者被诊断为 HIV（23 例 vs 17 例）和丙型肝炎病毒感染（101 例 vs 29 例）。与护士主导的 HIV/丙型肝炎病毒筛查算法相比，结果在患者出院前更常获得（HIV 87.2% vs 65.1%；丙型肝炎病毒 90.0% vs 65.4%），且更少患者需要重复筛查（HIV 1.6% vs 5.8%；丙型肝炎病毒 1.3% vs 4.5%）。
与护士主导的方案相比，针对成年患者的将 HIV/丙型肝炎病毒筛查自动链接到实验室检测的电子健康记录算法更有效。随着电子健康记录系统的广泛使用，这种模式可以轻松复制，应被视为未来计划的标准。
