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HealthHelp, 16945 Northchase Drive, Suite 1300, Houston, TX, 77060, USA.
Healthc (Amst). 2023 Sep;11(3):100704. doi: 10.1016/j.hjdsi.2023.100704. Epub 2023 Aug 21.
When a physician determines that a patient needs radiation therapy (RT), they submit an RT order to a prior authorization program which assesses guideline-concordance. A rule-based clinical decision support system (CDSS) evaluates whether the order is appropriate or potentially non-indicated. If potentially non-indicated, a board-certified oncologist discusses the order with the ordering physician. After discussion, the order is authorized, modified, withdrawn, or recommended for denial. Although patient race is not captured during ordering, bias prior to and during ordering, or during the discussion, may influence outcomes. This study evaluated if associations existed between race and order determinations by the CDSS and by the overall prior authorization program.
RT orders placed in 2019, pertaining to patients with Medicare Advantage health plans from one national organization, were analyzed. The association between race and prior authorization outcomes was examined for RT orders for all cancers, and then separately for breast, lung, and prostate cancers. Analyses controlled for the patient's age, urbanicity, and the median income in the patient's ZIP code. Adjusted analyses were conducted on unmatched and racially-matched samples.
Of the 10,145 patients included in the sample, 8,061 (79.5%) were White and 2,084 (20.5%) were Black. Race was not found to have a significant association with CDSS or prior authorization outcomes in any of the analyses.
CDSS and prior authorization outcomes suggested similar rates of clinical appropriateness of orders for patients, regardless of race.
Prior authorization utilizing rule-based CDSS was capable of enforcing guidelines without introducing racial bias.
当医生确定患者需要放射治疗 (RT) 时，他们会向事先授权计划提交 RT 医嘱，该计划评估指南的一致性。基于规则的临床决策支持系统 (CDSS) 评估医嘱是否合适或可能不适用。如果可能不适用，由认证肿瘤专家与下医嘱的医生讨论该医嘱。讨论后，医嘱被授权、修改、撤回或建议拒绝。尽管在下达医嘱时不记录患者的种族，但在下达医嘱之前和期间，或在讨论过程中，可能存在偏见，从而影响结果。本研究评估了 CDSS 和整个事先授权计划中种族与医嘱确定之间是否存在关联。
分析了来自一个全国性组织的 Medicare Advantage 健康计划的患者在 2019 年下达的 RT 医嘱。对于所有癌症的 RT 医嘱，以及对于乳腺癌、肺癌和前列腺癌的 RT 医嘱，分别检查了种族与事先授权结果之间的关联。分析控制了患者的年龄、城市性和患者邮政编码所在地区的中位数收入。在未匹配和种族匹配的样本中进行了调整分析。
在纳入的 10145 名患者中，8061 名（79.5%）为白人，2084 名（20.5%）为黑人。在任何分析中，种族与 CDSS 或事先授权结果均无显著关联。
CDSS 和事先授权结果表明，无论种族如何，医嘱的临床适宜性相似。
利用基于规则的 CDSS 进行事先授权能够在不引入种族偏见的情况下执行指南。
