Maccabitech institute for research and innovation, Maccabi Healthcare Services, Koyfman 4, Tel Aviv, Israel.
Medical Informatics, Maccabi healthcare services, Tel Aviv-Yafo, Israel.
Arch Osteoporos. 2020 Feb 26;15(1):27. doi: 10.1007/s11657-020-00718-3.
Computerized alerts for primary care physicians, provided during visits of patients who met treatment guidelines based on their electronic medical records, are an efficient method to raise awareness to many otherwise missed cases, especially after fracture.
Measure the efficacy of an automated real-time alert which was developed to assist osteoporosis management in the community.
The study population included treatment naïve patients with T-score ≤ - 2.5 or hip or vertebral fracture in a 2 million member Israeli health fund. On each ambulatory visit to a primary care physician or endocrinologist, a pop-up screen reminded the caregiver to consider treatment initiation. A follow-up "smart-set" screen conveniently gathered links to common actions (namely, (a) issue first line therapy prescription, (b) referral to nutritionist consultation, (c) laboratory tests relevant for osteoporosis, and (d) printing an information page for the patient). Time till treatment initiation was compared between the 3 years prior to and following the intervention.
Within 2 years since alert activation, a total of n = 21,070 cases were alerted, 52% of which were long standing cases: untreated for over 6 months since the event. During this period, a total of 30% initiated treatment purchases. As compared with the 3 years prior to the intervention, time till treatment initiation decreased following the intervention with HR = 1.05, 1.94, 1.29 (p values = 0.020, < 0.001, 0.005) for T-score, hip, and vertebral cases respectively. Initiation rates within 6 months increased from 52.0 to 59.8%, from 12.3 to 27.7%, and from 17.4 to 27.1% among T-score, hip, and vertebral cases, respectively (p value < 0.001). Male sex, nursing home residence, having diabetes or a cardiovascular disease and age younger than 60 or older than 80 were associated with lower treatment rates.
A computerized decision support system can efficiently raise attention to many otherwise missed high-risk osteoporotic cases, particularly those after fractures.
计算机提示在根据电子病历符合治疗指南的患者就诊期间提供给初级保健医生，是一种提高对许多否则可能漏诊病例的认识的有效方法，尤其是在骨折后。
测量一种自动化实时警报的功效，该警报旨在协助社区中的骨质疏松症管理。
研究人群包括在一个 200 万成员的以色列健康基金中，T 评分≤-2.5 或髋部或椎体骨折的治疗初治患者。在每次初级保健医生或内分泌科医生的门诊就诊时，弹出屏幕提醒护理人员考虑开始治疗。一个方便地收集常见操作链接的后续“智能集”屏幕（即，（a）开具一线治疗处方，（b）转介给营养师咨询，（c）与骨质疏松症相关的实验室检查，和（d）为患者打印信息页）。比较干预前后 3 年的治疗开始时间。
在警报激活后的 2 年内，共提醒了 21,070 例病例，其中 52%为长期病例：自事件发生以来未治疗超过 6 个月。在此期间，共有 30%开始购买治疗药物。与干预前 3 年相比，治疗开始时间在干预后缩短，HR=1.05、1.94、1.29（p 值=0.020、<0.001、0.005）分别用于 T 评分、髋部和椎体病例。6 个月内的起始率从 52.0%增加到 59.8%，从 12.3%增加到 27.7%，从 17.4%增加到 27.1%，分别用于 T 评分、髋部和椎体病例（p 值<0.001）。男性、疗养院居住、患有糖尿病或心血管疾病以及年龄小于 60 岁或大于 80 岁与较低的治疗率相关。
计算机化决策支持系统可以有效地提高对许多否则可能漏诊的高危骨质疏松病例的认识，特别是那些骨折后的病例。
