SUPPORT-AF: Piloting a Multi-Faceted, Electronic Medical Record-Based Intervention to Improve Prescription of Anticoagulation.
SUPPORT-AF: Piloting a Multi-Faceted, Electronic Medical Record-Based Intervention to Improve Prescription of Anticoagulation.
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DOI：
10.1161/jaha.118.009946
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发表时间：
2018-09-04
影响因子：
5.4
通讯作者：
McManus DD
中科院分区：
文献类型：
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作者：
Kapoor A;Amroze A;Golden J;Crawford S;O'Day K;Elhag R;Nagy A;Lubitz SA;Saczynski JS;Mathew J;McManus DD
符合条件的房颤患者中只有50%接受抗凝治疗。基于电子病历(EMR)的干预措施用于描述和提高提供者AC百分比的可行性和有效性尚不清楚。支持-房颤(通过房颤口服AC治疗的提供者档案支持AC的使用)研究旨在通过开发和向治疗房颤患者的提供者提供基于EMR的支持工具来提高遵守AC指南的比率。我们通过电子邮件向与我们机构有关联的心脏病专家和社区初级保健提供者报告了他们相对于同龄人的AC百分比。我们还在预约房颤患者的前一天向这些提供者发送了一条基于医疗记录的电子消息，该患者符合条件但没有接受AC。电子病历消息要求提供者与患者讨论AC，如果他或她认为合适的话。为了评估可行性，我们跟踪了供应商对我们通信的审查。我们还跟踪了干预提供者相对于没有接受我们干预的替代初级保健提供者的AC的变化。我们确定了分别由49名心脏病提供者、90名社区初级保健提供者和88名对照提供者护理的3786名、1054名和566名患者。在基线时，这3个组的AC百分比分别为71.3%、63.5%和58.3%。干预提供者分别有45%和96%的时间查看我们的电子邮件和电子病历消息。对于有反应的提供者，患者拒绝是患者不接受AC治疗的最常见原因(21%)，其次是高出血风险(19%)。在10周后的随访中，与对照组相比，心脏科或社区初级保健提供者的AC变化没有区别(分别低0.2%和高0.01%)。我们对AC的干预是可行的，但不足以增加我们人群中的AC。
Only 50% of eligible atrial fibrillation (AF) patients receive anticoagulation (AC). Feasibility and effectiveness of electronic medical record (EMR)–based interventions to profile and raise provider AC percentage is poorly understood. The SUPPORT‐AF (Supporting Use of AC Through Provider Profiling of Oral AC Therapy for AF) study aims to improve rates of adherence to AC guidelines by developing and delivering supportive tools based on the EMR to providers treating patients with AF. We emailed cardiologists and community‐based primary care providers affiliated with our institution reports of their AC percentage relative to peers. We also sent an electronic medical record–based message to these providers the day before an appointment with an atrial fibrillation patient who was eligible but not receiving AC. The electronic medical record message asked the provider to discuss AC with the patient if he or she deemed it appropriate. To assess feasibility, we tracked provider review of our correspondence. We also tracked the change in AC for intervention providers relative to alternate primary care providers not receiving our intervention. We identified 3786, 1054, and 566 patients cared for by 49 cardiology providers, 90 community‐based primary care providers, and 88 control providers, respectively. At baseline, the percentage of AC was 71.3%, 63.5%, and 58.3% for these 3 respective groups. Intervention providers reviewed our e‐mails and electronic medical record messages 45% and 96% of the time, respectively. For providers responding, patient refusal was the most common reason for patients not being on AC (21%) followed by high bleeding risk (19%). At follow‐up 10 weeks later, change in AC was no different for either cardiology or community‐based primary care providers relative to controls (0.2% lower and 0.01% higher, respectively). Our intervention profiling AC was feasible, but not sufficient to increase AC in our population.