Utility of an Electronic Health Record Report to Identify Patients with Delays in Testing for Poorly Controlled Diabetes.
Utility of an Electronic Health Record Report to Identify Patients with Delays in Testing for Poorly Controlled Diabetes.
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DOI：
10.1016/j.jcjq.2022.03.002
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发表时间：
2022-06
影响因子：
2.3
通讯作者：
Pitts, Samantha, I
中科院分区：
文献类型：
--
作者：
Schwartz, Jessica L.;Duan, Daisy;Maruthur, Nisa M.;Pitts, Samantha, I
降低血红蛋白A1c(HbA1c)对于糖尿病控制不佳的患者是必不可少的。然而，HbA1c检测的延迟是常见的，不完整的电子健康记录(EHR)阻碍了对逾期患者的识别。我们试图量化EHR报告正确识别HbA1c检测延迟患者的频率，并描述潜在的致病因素。使用EHR报告，我们确定了在2017年10月至2018年3月期间发生HbA1c>；9.0%且疑似延迟的成年患者(例如，在6个月内未出现另一例HbA1c)。我们对200条随机选择的记录进行了回溯性图表审查，以确认测试的延迟。从93张图表中收集二次测量来评估相关因素。我们确定了685名疑似延误的患者。复习图表(N=200)，确诊率为82.0%。9.0%的患者有及时的重复结果，但结果不是在EHR内的离散区域。另有8.5%的人预计永远不会回来。在确认的延迟中，患者经常接受生活方式咨询，但不到一半的患者记录了关于重复血糖测试的讨论。此外，74.2%的患者安排了及时的后续预约，但大多数(85.5%)的患者错过了。大多数怀疑HbA1c检测延迟的情况都得到了证实；然而，由于缺少数据或卫生系统外的后续护理，相当一部分人被错误分类。目前改善HbA1c数据质量的解决方案是劳动密集型的，并突出了更好地集成医疗保健数据的必要性。在延误治疗的患者中，错过预约的情况经常被注意到，这是一个潜在的改善目标。
Reducing hemoglobin A1c (HbA1c) is essential for patients with poorly controlled diabetes. However, delays in HbA1c testing are common and incomplete electronic health records (EHR) hinder identification of patients who are overdue. We sought to quantify how often an EHR report correctly identifies patients with HbA1c testing delays and to describe potential contributing factors. Using an EHR report, we identified adult patients who had an HbA1c > 9.0% between October 2017 and March 2018 and a suspected delay (e.g., another HbA1c had not resulted within 6 months). We performed a retrospective chart review of 200 randomly selected records to confirm delays in testing. Secondary measures were collected from 93 charts to evaluate associated factors. We identified 685 patients with suspected delays. On chart review (N = 200), 82.0% were confirmed. 9.0% of patients had a timely repeat result, but the result was not in a discrete field within the EHR. Another 8.5% were never expected to return. Among a subset of confirmed delays, patients often received lifestyle counseling, but less than half had documented discussions about repeat glycemic testing. Also, 74.2% had a timely follow-up appointment scheduled but the majority (85.5%) were missed. Most suspected delays in HbA1c testing were confirmed; however, a substantial minority were misclassified due to missing data or follow-up care outside the health system. Current solutions to improve data quality for HbA1c are labor intensive and highlight the need for better integration of health care data. Missed appointments were commonly noted among patients with delays in care and are a potential target for improvement.
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影响因子：
2.9
作者：
Johnson, Steven G.;Speedie, Stuart;Westra, Bonnie L.
通讯作者：
Westra, Bonnie L.
影响因子：
3.5
作者：
Hysong SJ;Sawhney MK;Wilson L;Sittig DF;Esquivel A;Singh S;Singh H
通讯作者：
Singh H
影响因子：
120.7
作者：
Smith, PC;Araya-Guerra, R;Pace, WD
通讯作者：
Pace, WD
影响因子：
5.7
作者：
Schectman, Joel M.;Schorling, John B.;Voss, John D.
通讯作者：
Voss, John D.
影响因子：
5.9
作者：
Singh, Hardeep;Thomas, Eric J.;Petersen, Laura A.
通讯作者：
Petersen, Laura A.