1811 Harvard Medical School, Boston, MA, USA.
1246 Indian Health Service, Rockville, MD, USA.
Public Health Rep. 2021 May;136(3):320-326. doi: 10.1177/0033354920970947. Epub 2020 Dec 10.
Indian Health Service (IHS) screening rates for are lower than national rates of chlamydia screening in the Southwest. We describe and evaluate the effect of a public health intervention consisting of electronic health record (EHR) reminders to alert health care providers to screen for chlamydia at an IHS facility. We also conducted an awareness presentation among health care providers on chlamydia screening.
We conducted our intervention from November 1, 2013, through October 31, 2015, at an IHS facility in the Southwest. We implemented algorithms that queried database values to assess chlamydia screening performance in 6 clinical departments. We presented data on the screening performance of clinical departments and health care providers (de-identified) in the awareness presentations. We re-queried database values 1 and 2 years after implementation of the EHR reminder intervention to evaluate before-and-after screening rates, comparing data among all patients and among female patients only.
We found small, sustained relative increases in chlamydia screening rates during the 2012-2015 evaluation period: 20.8% pre-intervention to 24.9% and 24.2% one and two years postintervention, respectively, across all patients; 32.3% preintervention to 36.6% and 35.6% one and two years postintervention, respectively, among female patients. Increases in clinical department-specific screening rates varied and were most prominent in internal medicine (35.8% preintervention to peak 65.8% postintervention). The 1 clinic (obstetrics-gynecology) that did not receive an awareness presentation showed a consistent downward trend in screening rates, although absolute rates were consistently higher in that clinic than in other clinics.
Awareness presentations that offer feedback to health care providers on screening performance, heighten provider awareness of the importance of chlamydia screening, and promote development of novel provider-initiated screening protocols may help to increase screening rates when combined with EHR reminders.
与西南地区全国衣原体筛查率相比，印第安健康服务（IHS）的筛查率较低。我们描述并评估了一项公共卫生干预措施的效果，该措施包括电子健康记录（EHR）提醒，以提醒医疗服务提供者在 IHS 设施中筛查衣原体。我们还在医疗服务提供者中进行了关于衣原体筛查的意识介绍。
我们于 2013 年 11 月 1 日至 2015 年 10 月 31 日在西南地区的 IHS 设施进行了干预。我们实施了算法，这些算法查询数据库值以评估 6 个临床科室的衣原体筛查表现。我们在意识介绍中介绍了临床科室和医疗服务提供者（去识别）的筛查表现数据。在实施 EHR 提醒干预措施 1 年和 2 年后，我们重新查询数据库值，以评估前后筛查率，比较所有患者和仅女性患者的数据。
我们发现，在 2012-2015 年评估期间，衣原体筛查率出现了持续的小幅度增长：所有患者的筛查率分别从干预前的 20.8%增加到干预后的 24.9%和 24.2%；女性患者的筛查率分别从干预前的 32.3%增加到干预后的 36.6%和 35.6%。临床科室特定筛查率的增加各不相同，内科（35.8%）最为明显，从干预前增加到 65.8%。未进行意识介绍的 1 个诊所（妇产科）的筛查率持续下降，尽管该诊所的绝对筛查率始终高于其他诊所。
提供反馈医疗服务提供者筛查表现的意识介绍，提高提供者对衣原体筛查重要性的认识，并促进制定新的提供者发起的筛查方案，当与 EHR 提醒相结合时，可能有助于提高筛查率。
