Division of Urology, Department of Surgery, University of Colorado Anschutz Medical Campus, Pediatric Urology Research Enterprise, Department of Pediatric Urology, Children's Hospital of Colorado, 13123 East 16Th Avenue, B-463, Aurora, CO, 80045, USA.
Ohio State University Wexner Medical Center, Columbus, OH, USA.
Pediatr Surg Int. 2022 Dec 1;39(1):25. doi: 10.1007/s00383-022-05314-9.
To evaluate the effect of a guidelines-based best practice alerts (BPA) in the electronic health record (EHR) on adherence to American Urological Association (AUA) vesicoureteral reflux (VUR) guidelines.
Retrospective cohort study of patients aged 0-17 years old with primary VUR with an initial urology clinic visit the year before or year after BPA implementation was done. Primary outcomes include obtaining vital signs, urinalysis, and ultrasound at initial and 1-year follow-up visit.
We identified 123 patients with initial visits during the study period, 58 of whom returned for 1-year follow-up visits. Patients seen post-BPA were more likely to have height measured at initial visit than those seen pre-BPA (47.3% vs. 11.8%, p < 0.001). The majority of patients were screened with weight (98.3%) and ultrasound (87.9%) at 1-year follow-up both before and after BPA implementation. Neither blood pressure measurements (59.1% vs. 55.6%, p > 0.5) nor urinalysis orders (23.8% vs. 19.4%, p > 0.05) significantly increased post-BPA.
The use of an EHR-based BPA increased the likelihood of obtaining height measurements by clinic intake staff but did not significantly affect provider adherence to other practice guideline recommendations. Our findings suggest that BPA implementation alone is not sufficient to impact provider uptake of VUR guideline recommendations.
评估电子健康记录（EHR）中基于指南的最佳实践警报（BPA）对遵守美国泌尿外科学会（AUA）膀胱输尿管反流（VUR）指南的影响。
对在 BPA 实施前一年或后一年首次就诊泌尿科门诊的 0-17 岁原发性 VUR 患者进行回顾性队列研究。主要结局包括在初始和 1 年随访时获得生命体征、尿液分析和超声检查。
我们确定了在研究期间有 123 名患者进行了初始就诊，其中 58 名患者进行了 1 年随访。与 BPA 实施前相比，BPA 实施后首次就诊时更有可能测量身高（47.3% vs. 11.8%，p<0.001）。大多数患者在 BPA 实施前后 1 年随访时均接受了体重（98.3%）和超声（87.9%）筛查。血压测量（59.1% vs. 55.6%，p>0.5）和尿液分析医嘱（23.8% vs. 19.4%，p>0.05）均无显著增加。
使用基于 EHR 的 BPA 增加了就诊工作人员获取身高测量的可能性，但并未显著影响医生对其他实践指南建议的遵守情况。我们的研究结果表明，仅实施 BPA 不足以影响医生对 VUR 指南建议的采纳。
