Stop the denosumab delay! The effect of implementing an automatic reminder in the electronic medical record.
Stop the denosumab delay! The effect of implementing an automatic reminder in the electronic medical record.
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DOI：
10.1007/s11657-022-01065-1
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发表时间：
2022-01-20
影响因子：
3
通讯作者：
Billups SJ
中科院分区：
文献类型：
--
作者：
Zaman A;Rothman MS;Billups SJ
我们研究的目的是评估在实施结构化订购计划（带有自动提醒）前后延迟地舒单抗给药的频率。我们对720名骨质疏松症成年患者进行了回顾性图表审查，这些患者在计划生效之前和之后在UCHealth系统内接受了至少两次Denosumab剂量。在实施自动提醒后，延迟给药从24.0%（PRE）显著降低至12.6%（POST）（p <0.001）。由于计划问题导致的地舒单抗给药延迟的比例在PRE和POST时间段之间显著降低（16.4% vs. 3.3%，p=0.011），而患者相关问题从31.2%增加至46.7%（p=0.041）。两个时间段之间的提供者、医疗和其他/未知问题的发生率没有差异。当标准化为随访患者年时，两组的骨折数量相同，均为0.016例骨折/患者年。PRE组和POST组的骨折均与给药延迟相关，但研究没有把握度检测组间骨折发生率的差异。带有自动提醒的电子记录可减少地舒单抗给药延迟，并可能导致延迟相关骨折减少。用于骨质疏松症治疗的地舒单抗给药延迟可能导致快速骨丢失或骨折增加。我们评估了在实施结构化订购计划（带有自动提醒）之前和之后延迟地舒单抗给药的频率，发现延迟地舒单抗给药的比例减少了一半。
The purpose of our study was to assess the frequency of delayed denosumab dosing before and after the implementation of a structured ordering plan with automated reminders. We conducted a retrospective chart review of 720 adults with osteoporosis who received at least two denosumab doses within the UCHealth system before and after the plan went into effect. There was a significant reduction in delayed dosing from 24.0% (PRE) to 12.6% (POST) (p <0.001) after implementation of the automated reminder. The fraction of delayed denosumab doses due to scheduling issues decreased significantly between PRE and POST time periods (16.4% vs. 3.3%, p=0.011), while patient-related issues increased from 31.2% to 46.7% (p=0.041). The rate of provider, medical, and other/unknown issues did not differ between the two time periods. When normalized to patient-years of follow-up, the number of fractures was the same for both groups at 0.016 fractures per patient-year. Fractures in both the PRE and POST groups were related to dosing delays, but the study was not powered to detect differences in fractures rates between the groups. Electronic records with automatic reminders can reduce delayed dosing of denosumab and may lead to reductions in fractures associated with delays. Delays in denosumab dosing for osteoporosis treatment may lead to rapid bone loss or increased fractures. We assessed the frequency of delayed denosumab dosing before and after the implementation of a structured ordering plan with automated reminders and found that the rate of delayed denosumab dosing was cut in half.
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