氟保护漆在儿童中的应用：被动临床决策支持辅助下的低成本、高价值实施。
The Application of Dental Fluoride Varnish in Children: A Low Cost, High-Value Implementation Aided by Passive Clinical Decision Support.
机构信息
Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States.
Office of Health Informatics and Analytics, University of California, Los Angeles, Los Angeles, California, United States.
出版信息
Appl Clin Inform. 2023 Mar;14(2):245-253. doi: 10.1055/a-2011-8167. Epub 2023 Jan 12.
BACKGROUND
Fluoride is vital in the prevention of dental caries in children. In 2014, the U.S. Preventive Services Task Force deemed fluoride varnish a recommended preventive service (grade B). Electronic health record-based clinical decision support (CDS) tools have shown variable ability to alter physicians' ordering behaviors.
OBJECTIVES
This study aimed to increase the application of fluoride varnish in children while analyzing the effect of two passive CDS tools-an order set and a note template.
METHODS
Data on outpatient pediatric visits over an 18-month period before and after CDS implementation (October 15, 2020-April 15, 2022) were queried, while trends in application rate of fluoride were examined. We constructed a multiple logistic regression model with a primary outcome of whether a patient received fluoride at his/her visit. The primary predictor was a "phase" variable representing the CDS implemented. Physician interaction with CDS as well as the financial effects of the resulting service use were also examined.
RESULTS
There were 3,049 well-child visits of children aged 12 months to 5 years. The addition of a fluoride order to a "Well Child Check" order set led to a 10.6% increase in ordering over physician education alone (25.4 vs. 14.8%, = 0.001), while the insertion of fluoride-specific text to drop-down lists in clinical notes led to a 6.2% increase (31.5 vs. 25.4%, = 0.005). Whether a patient received topical fluoride was positively associated with order set implementation (odds ratio [OR] = 5.87, 95% confidence interval [CI]: 4.20-8.21) and fluoride-specific drop-down lists (OR = 7.81, 95% CI: 5.41-11.28). Female providers were more likely to use order sets when ordering fluoride (56.2 vs. 40.9% for males, ≤ 0.0001). Added revenue totaled $15,084.
CONCLUSION
The targeted use of order sets and note templates was positively associated with the ordering of topical fluoride by physicians.
背景
氟化物对于预防儿童龋齿至关重要。2014 年，美国预防服务工作组（U.S. Preventive Services Task Force）将氟化物涂料视为推荐的预防服务（B 级）。基于电子健康记录的临床决策支持（CDS）工具已显示出改变医生开方行为的不同能力。
目的
本研究旨在增加儿童使用氟化物涂料的比例，并分析两种被动 CDS 工具（医嘱集和医嘱模板）的效果。
方法
在实施 CDS 前后（2020 年 10 月 15 日至 2022 年 4 月 15 日）查询了 18 个月的门诊儿科就诊数据，同时检查了氟化物应用率的趋势。我们构建了一个多变量逻辑回归模型，主要结果是患者在就诊时是否接受了氟化物。主要预测因素是代表实施 CDS 的“阶段”变量。还检查了医生与 CDS 的交互作用以及由此产生的服务使用的财务影响。
结果
共有 3049 名 12 个月至 5 岁儿童的常规健康检查。在“儿童常规健康检查”医嘱集中添加氟化物医嘱会使开方率比单纯医生教育增加 10.6%（25.4%比 14.8%，=0.001），而在临床记录中的下拉列表中插入氟化物专用文本会使开方率增加 6.2%（31.5%比 25.4%，=0.005）。患者是否接受局部用氟化物与医嘱集的实施呈正相关（比值比[OR] = 5.87，95%置信区间[CI]：4.20-8.21）和氟化物专用下拉列表（OR = 7.81，95% CI：5.41-11.28）。女性医生在开氟化物医嘱时更倾向于使用医嘱集（56.2%比男性医生的 40.9%，≤0.0001）。新增收入总计 15084 美元。
结论
有针对性地使用医嘱集和医嘱模板与医生开出局部用氟化物呈正相关。
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