Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America.
Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States of America.
PLoS One. 2022 Jul 1;17(7):e0270394. doi: 10.1371/journal.pone.0270394. eCollection 2022.
Analyses of electronic medical databases often compare clinical practice to guideline recommendations. These analyses have a limited ability to simultaneously evaluate many interconnected medical decisions. We aimed to overcome this limitation with an alternative method and apply it to the diagnostic workup of HIV, where misuse can contribute to HIV transmission, delay care, and incur unnecessary costs.
We used graph theory to assess patterns of HIV diagnostic testing in a national healthcare system. We modeled the HIV diagnostic testing guidelines as a directed graph. Each node in the graph represented a test, and the edges pointed from one test to the next in chronological order. We then graphed each patient's HIV testing. This set of patient-level graphs was aggregated into a single graph. Finally, we compared the two graphs, the first representing the recommended approach to HIV diagnostic testing and the second representing the observed patterns of HIV testing, to assess for clinical practice deviations.
The HIV diagnostic testing of 1.643 million patients provided 8.790 million HIV diagnostic test results for analysis. Significant deviations from recommended practice were found including the use of HIV resistance tests (n = 3,007) and HIV nucleic acid tests (n = 16,567) instead of the recommended HIV screen.
We developed a method that modeled a complex medical scenario as a directed graph. When applied to HIV diagnostic testing, we identified deviations in clinical practice from guideline recommendations. The model enabled the identification of intervention targets and prompted systemwide policy changes to enhance HIV detection.
电子病历数据库的分析通常将临床实践与指南建议进行比较。这些分析方法的能力有限，无法同时评估许多相互关联的医疗决策。我们旨在通过一种替代方法克服这一限制，并将其应用于 HIV 的诊断工作中，因为在 HIV 的诊断工作中误用可能会导致 HIV 的传播、延迟护理并产生不必要的费用。
我们使用图论来评估国家医疗保健系统中 HIV 诊断检测的模式。我们将 HIV 诊断检测指南建模为有向图。图中的每个节点代表一项检测，边按时间顺序从一项检测指向下一项检测。然后，我们绘制每个患者的 HIV 检测图。这组患者级别的图被聚合为一个单独的图。最后，我们比较了这两个图，第一个图代表 HIV 诊断检测的推荐方法，第二个图代表 HIV 检测的实际模式，以评估临床实践偏差。
对 164.3 万名患者的 HIV 诊断检测提供了 8790 万次 HIV 诊断检测结果进行分析。发现了与推荐实践的重大偏差，包括使用 HIV 耐药性检测（n=3007）和 HIV 核酸检测（n=16567）代替推荐的 HIV 筛查。
我们开发了一种将复杂的医疗情况建模为有向图的方法。当应用于 HIV 诊断检测时，我们确定了临床实践与指南建议之间的偏差。该模型确定了干预目标，并促使整个系统的政策变化，以增强 HIV 的检测。
