Department of Gastroenterology, NorthShore University Health System, Evanston, Illinois, USA.
Department of Medicine, NorthShore University Health System, Evanston, Illinois, USA.
Clin Transl Gastroenterol. 2021 Jan 12;12(1):e00297. doi: 10.14309/ctg.0000000000000297.
We assessed the influence of a best practice alert (BPA) embedded within the electronic medical record on improving hepatitis C virus (HCV) birth-cohort screening by primary care physicians (PCPs).
Screening by 155 PCPs was monitored during 2 consecutive 9-month periods before and after implementation of the BPA. All tests were reviewed to differentiate true screening from other testing indications.
Of 155 PCPs, 131 placed screening orders before and after BPA. Twenty-two PCPs started testing after BPA (P = 0.02). The number of tests placed and screening rates per PCP increased from 16 to 84 and from 3.3% to 13.2%, respectively (P < 0.0001). Before BPA, most PCPs rarely ordered screening HCV tests, whereas a small group of physicians generated most tests, indicative of an underlying power-law distribution. After the BPA, a new group of high-performing PCPs emerged, whose screening patterns were again characterized by a power-law distribution. However, pre-BPA test rates of individual PCPs were not predictive of their post-BPA rates. Overall, the introduction of the BPA narrowed the gap between low- and high-performing testers, indicating that modest increases in testing by a large number of low-performing PCPs could drive substantial improvement in program implementation.
HCV birth-cohort screening by PCPs was shaped by an underlying power-law distribution. This distribution was preserved after the implementation of a BPA, although pre-BPA test rates were not predictive of post-BPA rates. Increases in test rates by high- and low-performing PCPs both contributed to the overall success of the BPA.
我们评估了电子病历中嵌入的最佳实践警报（BPA）对改善初级保健医生（PCP）对丙型肝炎病毒（HCV）出生队列筛查的影响。
在实施 BPA 前后连续两个 9 个月期间，监测了 155 名 PCP 的筛查情况。所有测试均进行了审查，以区分真正的筛查与其他测试指征。
在 155 名 PCP 中，有 131 名在 BPA 前后下达了筛查医嘱。22 名 PCP 在 BPA 后开始进行检测（P=0.02）。每位 PCP的检测数量和筛查率分别从 16 项增加到 84 项，从 3.3%增加到 13.2%（P<0.0001）。在 BPA 之前，大多数 PCP 很少下令进行 HCV 筛查检测，而一小部分医生进行了大多数检测，表明存在潜在的幂律分布。在 BPA 之后，出现了一组新的高绩效 PCP，他们的筛查模式再次表现出幂律分布。然而，BPA 之前的个别 PCP 的测试率并不能预测他们 BPA 之后的测试率。总体而言，BPA 的引入缩小了低绩效和高绩效测试者之间的差距，表明大量低绩效 PCP 的适度测试增加可以推动计划实施的大幅改善。
PCP 对 HCV 出生队列的筛查受到潜在幂律分布的影响。实施 BPA 后，该分布得以保留，尽管 BPA 之前的测试率不能预测 BPA 后的测试率。高绩效和低绩效 PCP 的测试率增加都对 BPA 的整体成功做出了贡献。
