电子健康记录决策支持警报对减少过度宫颈癌筛查的影响。
Effect of an Electronic Health Record Decision Support Alert to Decrease Excess Cervical Cancer Screening.
机构信息
Department of Obstetrics, Gynecology & Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN.
School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
出版信息
J Low Genit Tract Dis. 2019 Oct;23(4):253-258. doi: 10.1097/LGT.0000000000000484.
OBJECTIVE
Cervical cancer screening is often conducted in excess of current screening guidelines. The objective of this study was to evaluate the effect of an electronic health record (EHR) clinical decision support alert to decrease guideline-nonadherent cervical cancer screening beyond the age limits of screening or posthysterectomy.
MATERIALS AND METHODS
The proportion of guideline-nonadherent Pap tests in women younger than 21 years or older than 65 years or posthysterectomy were compared 4 months before and 3 months after implementation of an EHR clinical decision support alert warning providers that a Pap test is not indicated. Providers could cancel the Pap test or override the alert and place the order. Provider characteristics and Pap test indications were summarized by preintervention/postintervention period using descriptive statistics. The proportions of nonindicated Pap tests were compared by intervention period and provider characteristics using generalized estimating equation models.
RESULTS
In women beyond the screening age limits or posthysterectomy, a total of 388 Pap tests were ordered before intervention, and 313 tests were ordered after intervention. Proportion of guideline-nonadherent tests was similar before (62%) and after intervention (63%); thus, implementation of the clinical decision support alert did not change the proportion of guideline-nonadherent Pap tests ordered (OR = 1.08, 95% CI = 0.77-1.52). It is notable that 52% of guideline-nonadherent tests were ordered by 11 providers. Even when controlling for providers who ordered more than 1 test during the study period, multivariate analysis showed that male providers were more likely to order guideline-nonadherent Pap tests (OR = 2.30, 95% CI = 1.36-3.89); no other differences by provider characteristics were observed.
CONCLUSIONS
An EHR clinical decision support alert does not decrease guideline-nonadherent cervical cancer screening. These data suggest efforts to optimize clinical decision support should be focused on other aspects of cervical cancer prevention.
目的
宫颈癌筛查通常超出当前筛查指南的规定。本研究的目的是评估电子健康记录（EHR）临床决策支持警报的效果，以减少不符合指南的宫颈癌筛查，包括年龄限制内的筛查或子宫切除术后的筛查。
材料和方法
比较了在实施 EHR 临床决策支持警报之前的 4 个月和之后的 3 个月内，年龄小于 21 岁或大于 65 岁或子宫切除术后的女性中不符合指南的巴氏试验比例。提供者可以取消巴氏试验或覆盖警报并下达订单。使用描述性统计数据按干预前/干预后时期总结提供者特征和巴氏试验指征。使用广义估计方程模型，按干预时期和提供者特征比较非指示性巴氏试验的比例。
结果
在年龄限制外或子宫切除术后的女性中，干预前共下达了 388 次巴氏试验，干预后下达了 313 次。不符合指南的试验比例在干预前（62%）和干预后（63%）相似；因此，实施临床决策支持警报并未改变不符合指南的巴氏试验比例（OR=1.08，95%CI=0.77-1.52）。值得注意的是，52%的非指示性试验是由 11 名提供者下达的。即使在控制研究期间下达了超过 1 次试验的提供者，多变量分析也表明，男性提供者更有可能下达不符合指南的巴氏试验（OR=2.30，95%CI=1.36-3.89）；未观察到其他提供者特征差异。
结论
EHR 临床决策支持警报并不能减少不符合指南的宫颈癌筛查。这些数据表明，优化临床决策支持的努力应集中在宫颈癌预防的其他方面。
Zotero 插件