Jt Comm J Qual Patient Saf. 2022 Jun-Jul;48(6-7):335-342. doi: 10.1016/j.jcjq.2022.03.002. Epub 2022 Apr 2.
Reducing hemoglobin A1c (HbA1c) is essential for patients with poorly controlled diabetes. However, delays in HbA1c testing are common, and incomplete electronic health record (EHR) reports hinder identification of patients who are overdue. This study sought to quantify how often an EHR report correctly identifies patients with HbA1c testing delays and to describe potential contributing factors.
Using an EHR report, the researchers identified adult patients who had an HbA1c > 9.0% between October 2017 and March 2018 and a suspected delay (for example, another HbA1c had not resulted within six months). A retrospective chart review of 200 randomly selected records was performed to confirm delays in testing. Secondary measures were collected from 93 charts to evaluate associated factors.
A total of 685 patients with suspected delays were identified. On chart review (N = 200), 82.0% were confirmed. Nine percent of patients had a timely repeat result, but the result was not in a discrete field within the EHR. Another 8.5% were never expected to return. Among a subset of confirmed delays, patients often received lifestyle counseling, but less than half had documented discussions about repeat glycemic testing. Also, 74.2% had a timely follow-up appointment scheduled but the majority (85.5%) were missed.
Most suspected delays in HbA1c testing were confirmed; however, a substantial minority were misclassified due to missing data or follow-up care outside the health system. Current solutions to improve data quality for HbA1c are labor intensive and highlight the need for better integration of health care data. Missed appointments were commonly noted among patients with delays in care and are a potential target for improvement.
对于血糖控制不佳的糖尿病患者，降低血红蛋白 A1c（HbA1c）至关重要。然而，HbA1c 检测常会出现延迟，且电子健康记录（EHR）报告不完整会阻碍识别出需要复查的患者。本研究旨在量化 EHR 报告正确识别 HbA1c 检测延迟患者的频率，并描述潜在的促成因素。
研究人员使用 EHR 报告，识别出 2017 年 10 月至 2018 年 3 月间 HbA1c＞9.0%且疑似存在检测延迟（例如，HbA1c 结果在六个月内尚未得出）的成年患者。对 200 份随机选定记录进行回顾性病历审查，以确认检测是否延迟。还从 93 份病历中收集次要指标，以评估相关因素。
共确定了 685 例疑似延迟的患者。在病历审查（n=200）中，82.0%得到了确认。9%的患者有及时的重复结果，但该结果未在 EHR 的离散字段中。另有 8.5%的患者从未预期会返回。在一组确认的延迟患者中，患者经常接受生活方式咨询，但不到一半的患者有关于重复血糖检测的记录。此外，74.2%的患者有及时的随访预约，但大多数（85.5%）都错过了。
大多数疑似 HbA1c 检测延迟的情况得到了确认；然而，由于数据缺失或医疗系统外的后续护理，少数情况被错误分类。目前，提高 HbA1c 数据质量的解决方案需要大量人力，突出了更好地整合医疗保健数据的必要性。在延迟治疗的患者中经常出现错过预约的情况，这是一个潜在的改进目标。
