Electronic health record alerts enhance mass screening for chronic hepatitis B.
Electronic health record alerts enhance mass screening for chronic hepatitis B.
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DOI：
10.1038/s41598-020-75842-8
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发表时间：
2020-11-05
影响因子：
4.6
通讯作者：
Bowlus C
中科院分区：
文献类型：
--
作者：
Chak E;Li CS;Chen MS Jr;MacDonald S;Bowlus C
旨在衡量电子健康记录 (EHR) 警报对高危亚洲和太平洋岛民 (API) 慢性乙型肝炎 (CHB) 筛查的影响。尚未完成乙型肝炎表面抗原 (HBsAg) 检测的 API 患者通过基于 EHR 的新型人群健康工具进行识别。第 1 组（主要是私人保险）和第 2 组（包括 Medicare 和/或 Medicaid）中的 API 风险患者被随机分配，以决定是否在电子病历中激活警报。总共有 8299 个 API 在我们的卫生系统内被发现在 HBsAg 完成基线方面存在缺陷。在队列 1 中，1542 名患者和 1568 名患者分别被随机分配到警报组和对照组。在队列 2 中，2599 名患者和 2590 名患者分别被随机分配到警报组和对照组。对于这两个队列，警报组完成了 389 次 HBsAg 检测，而对照组完成了 177 次 HBsAg 检测（p < 0.0001；OR = 2.3；95% CI 1.94–2.80），但警报组中 HBsAg 阳性检出率并未增加（分别为 15 例和 13 例）。 p = 0.09；OR = 0.5；95% CI 0.24–1.09）。我们的结果表明，个性化、自动化的电子警报可增加慢性乙型肝炎的筛查，但需要更全面的措施来检测 HBsAg 阳性患者。 NIH 试验登记号：NCT04240678。
To measure the effect of an electronic health record (EHR) alert on chronic hepatitis B (CHB) screening among at-risk Asian and Pacific Islanders (API). API patients who had not yet completed hepatitis B surface antigen (HBsAg) testing were identified by a novel EHR-based population health tool. At-risk API patients in Cohort 1 (primarily privately insured) and Cohort 2 (includes Medicare and/or Medicaid) were randomized to alert activation in their electronic medical charts or not. In total, 8299 API were found to be deficient in HBsAg completion at baseline within our health system. In Cohort 1, 1542 patients and 1568 patients were randomized to the alert and control respectively. In Cohort 2, 2599 patients and 2590 patients were randomized to the alert and control respectively. For both cohorts combined, 389 HBsAg tests were completed in the alert group compared to 177 HBsAg tests in the control group (p < 0.0001; OR = 2.3; 95% CI 1.94–2.80), but there was no increased detection of HBsAg positivity from the alert (15 versus 13 respectively, p = 0.09; OR = 0.5; 95% CI 0.24–1.09). Our results demonstrate that personalized, automated electronic alerts increase screening for CHB, but more comprehensive measures are needed to detect HBsAg positive patients. NIH Trial Registry Number: NCT04240678.
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