Evaluation of an Electronic Health Record Tool to Identify Echocardiograms That Do Not Change Clinical Care.
Evaluation of an Electronic Health Record Tool to Identify Echocardiograms That Do Not Change Clinical Care.
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评估电子健康记录工具，以识别不改变临床护理的超声心动图。
DOI：
10.1016/j.echo.2023.08.019
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Woo,HawkinE
中科院分区：
文献类型：
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作者：
Leuchter,RichardK;Gulhar,Radhika;Maynick,JeffD;Dardick,LawrenceD;Vorobiof,Gabriel;Tabibiazar,Ramin;Yang,RobertM;Sarkisian,CatherineA;Woo,HawkinE
经胸超声心动图（TTE）的可获得性和可负担性使其在许多疾病的管理中不可或缺，尽管这些优点也导致了TTE的过度使用。1-3尽管有许多精心设计的干预措施，包括3教育，审计/反馈和决策支持工具，以遏制TTE过度使用，但仍然需要新的，具有成本效益的策略，可以持续减少医疗保健5系统的过度使用。1，4，5在这项针对两家医院的单一卫生系统研究中，我们试图设计一种6电子健康记录（EHR）工具，该工具可以准确识别没有主动改变临床护理的TTE，从而可以用于未来的干预措施，以减少订单输入时的TTE过度使用。9从2021年6月开始，我们修改了住院TTE医嘱编写器，根据ACC/AHA 2011超声心动图适当使用标准（AUC）中的适应症12（图1），将10个非结构化自由文本适应症字段替换为级联结构化适应症复选框。我们设计了一个EHR工具，该工具查询选定的复选框，以静默标记TTE 13，1）在前一次TTE的14天内重复，2）符合根据超声心动图AUC的14个适当性评分较低的10种情况之一（图2）。两名医院的15名内科医生（对选定的适应症和标记状态设盲）审查了所有标记病例和16名随机选择的相同数量的未标记对照，以根据先前的方法确定17名患者的TTE临床影响（图2）。3例针对任何重症监护服务完成的TTE和18例多种适应症从分析中排除。我们使用卡方检验比较了标记组与未标记组之间的临床影响（主要结局）和与20例既往TTE（次要结局）相比完全不变的TTE数量。研究方案21已获得UCLA Health IRB的批准。22
The accessibility and affordability of transthoracic echocardiograms (TTEs) make them 1 indispensable in the management of numerous illnesses, though these virtues also contribute to 2 substantial TTE overuse. 1–3 Despite numerous well-designed interventions consisting of 3 education, audit/feedback, and decision support tools to curb TTE overuse, there still exists a 4 need for novel, cost-effective strategies that can sustainably reduce overuse across healthcare 5 systems. 1, 4, 5 In this single health system study across two hospitals, we sought to design an 6 electronic health record (EHR) tool that could accurately identify TTEs that did not actively 7 change clinical care, and thus could be used in future interventions to reduce TTE overuse at the 8 time of order entry. 9Starting June 2021, we modified the inpatient TTE order composer to replace the 10 unstructured free-text indication field with cascading structured indication checkboxes based on 11 the indications in the ACC/AHA 2011 appropriate use criteria (AUC) for echocardiography 12 (Figure 1). We designed an EHR tool that queried the selected checkboxes to silently flag TTEs 13 that 1) were repeated within 14 days from a prior TTE, and 2) met one of ten scenarios with low 14 appropriateness scores according to echocardiography AUC (Figure 2). Two hospital-based 15 internists (blinded to selected indications and flagged status) chart reviewed all flagged cases and 16 an equal number of randomly selected unflagged controls, to determine TTE clinical impact in 17 accordance with prior methods (Figure 2). 3 TTEs completed on any critical care service and for 18 multiple indications were excluded from analysis. We used chi-square tests to compare clinical 19 impact (primary outcome) and the number of TTEs that were completely unchanged from the 20 prior TTE (secondary outcome) between flagged versus unflagged groups. The study protocol 21 was approved by the UCLA Health IRB. 22