Electronic Medical Alerts Increase Screening for Chronic Hepatitis B: A Randomized, Double-Blind, Controlled Trial
Electronic Medical Alerts Increase Screening for Chronic Hepatitis B: A Randomized, Double-Blind, Controlled Trial
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DOI：
10.1158/1055-9965.epi-18-0448
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发表时间：
2018-11-01
影响因子：
3.8
通讯作者：
Bowlus, Christopher
中科院分区：
文献类型：
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作者：
Chak, Eric;Taefi, Amir;Bowlus, Christopher
背景：在外国出生的高危人群中慢性乙型肝炎 (CHB) 筛查建议的实施效果并不理想。电子健康记录 (EHR) 中警报和提醒的使用增加了对其他常见病症的筛查。我们研究的目的是衡量 EH K 警报对外国出生的亚洲和太平洋岛民 (API) 患者实施乙型肝炎表面抗原 (HBsAg) 筛查的有效性。方法：我们使用一种新技术，通过自我识别的种族、姓氏、原籍国和语言偏好来识别 API 患者，并且这些患者在 EHR 中没有用 HBsAg 进行 CHB 筛查的记录。由于在本研究时缺乏常规 HBsAg 筛查的覆盖范围，拥有 Medicare 和/或 Medicaid 保险的患者被排除在外。高危 API 患者被随机分配到其 EHR 中是否激活警报（对照）。结果：共有 2,987 名患者符合纳入标准，并被随机分配到警报组 (n = 1,484) 或对照组 (n = 1,503)。在警报组中，有 119 名患者接受了 HBsAg 检测，而对照组有 48 名患者接受了 HBsAg 检测（比值比，2.64；95% 置信区间，1.88-3.73；P < 0.001）。在警报组中，119 人中有 4 人 (3.4%) 检测出 HBsAg 阳性，而对照组 48 人中只有 5 人 (10.4%) (P = 0.12)。结论：EHR 警报显着增加了外国出生的 API 中的 HBsAg 检测。影响：EHR 警报的利用有可能改善乙型肝炎筛查指南的实施。 (C) 2018 年 AACR。
Background: Implementation of screening recommendations for chronic hepatitis B (CHB) among foreign-born persons at risk has been sub-optimal. The use of alerts and reminders in the electronic health record (EHR) has led to increased screening for other common conditions. The aim of our study was to measure the effectiveness of an EH K alert on the implementation of hepatitis B surface antigen (HBsAg) screening of foreign-born Asian and Pacific Islander (API) patients.Methods: We used a novel technique to identify API patients by self-identified ethnicity, surname, country of origin, and language preference, and who had no record of CHB screening with HBsAg within the EHR. Patients with Medicare and/or Medicaid insurance were excluded due to lack of coverage for routine HBsAg screening at the time of this study.At-risk API patients were randomized to alert activation in their EHR or not (control).Results: A total of 2,987 patients met inclusion criteria and were randomized to the alert (n = 1,484) or control group (n = 1,503). In the alert group, 119 patients were tested for HBsAg, compared with 48 in the control group (odds ratio, 2.64; 95% confidence interval, 1.88-3.73; P < 0.001). In the alert group, 4 of 119 (3.4%) tested HBsAg-positive compared with 5 of 48 (10.4%) in the control group (P = 0.12).Conclusions: An EHR alert significantly increased HBsAg testing among foreign-born APIs.Impact: Utilization of EHR alerts has the potential to improve implementation of hepatitis B-screening guidelines. (C) 2018 AACR.