Impact of Patient Reminders on Papanicolaou Test Completion for High-Risk Patients Identified by a Clinical Decision Support System.
Impact of Patient Reminders on Papanicolaou Test Completion for High-Risk Patients Identified by a Clinical Decision Support System.
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DOI：
10.1089/jwh.2017.6667
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发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Chaudhry R
中科院分区：
文献类型：
--
作者：
MacLaughlin KL;Kessler ME;Komandur Elayavilli R;Hickey BC;Scheitel MR;Wagholikar KB;Liu H;Kremers WK;Chaudhry R
背景：用于宫颈癌筛查的临床决策支持系统(CDSS)确定应进行常规宫颈癌筛查的患者。然而，需要更频繁的筛查或更早的随访以解决过去异常结果的高危患者没有被识别出来。我们的目的是评估复杂的CDSS的效果，包括高危患者筛查和异常结果管理的国家指南，其实施以识别逾期检测的患者，以及发送有针对性的后续建议的结果。材料和方法：在一个学术医学中心附属的三个初级保健诊所，向CDSS确定的18至65岁逾期检测的高危妇女(干预组)发出提醒，建议预约进行巴氏杆菌(Pap)检测或巴氏和人乳头状瘤病毒联合检测。没有收到提醒的历史对照患者在向干预组发送提醒的日期前一年通过CDSS进行识别。通过广义估计方程扩展，比较干预组和对照组之间的测试完成率。结果：在三个地点中，干预组推荐的随访测试的平均完成率为23.7%(61/257)，高于对照组的3.3%(17/516)(p <； 0.001)。结论：CDSS具有增强的能力，能够识别超出常规筛查间隔的高危妇女进行宫颈癌检测，并随后通知患者，通过提高对遵循指南的后续跟踪和所需治疗的遵守，有可能减少宫颈癌前病变和癌症。
Background: A clinical decision support system (CDSS) for cervical cancer screening identifies patients due for routine cervical cancer screening. Yet, high-risk patients who require more frequent screening or earlier follow-up to address past abnormal results are not identified. We aimed to assess the effect of a complex CDSS, incorporating national guidelines for high-risk patient screening and abnormal result management, its implementation to identify patients overdue for testing, and the outcome of sending a targeted recommendation for follow-up. Materials and Methods: At three primary care clinics affiliated with an academic medical center, a reminder recommending an appointment for Papanicolaou (Pap) testing or Pap and human papillomavirus cotesting was sent to high-risk women aged 18 through 65 years (intervention group) identified by CDSS as overdue for testing. Historical control patients, who did not receive a reminder, were identified by CDSS 1 year before the date when reminders were sent to the intervention group. Test completion rates were compared between the intervention and control groups through a generalized estimating equation extension. Results: Across the three sites, the average completion rate of recommended follow-up testing was significantly higher in the intervention group at 23.7% (61/257) than the completion rate at 3.3% (17/516) in the control group (p < 0.001). Conclusions: A CDSS with enhanced capabilities to identify high-risk women due for cervical cancer testing beyond routine screening intervals, with subsequent patient notification, has the potential to decrease cervical precancer and cancer by improving adherence to guideline-compliant follow-up and needed treatment.
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临床决策支持具有自动化文本处理，用于宫颈癌筛查。
DOI：
10.1136/amiajnl-2012-000820
发表时间：
2012-09
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Wagholikar KB;MacLaughlin KL;Henry MR;Greenes RA;Hankey RA;Liu H;Chaudhry R
通讯作者：
Chaudhry R
影响因子：
12.7
作者：
JANERICH, DT;HADJIMICHAEL, O;POLEDNAK, AP
通讯作者：
POLEDNAK, AP
影响因子：
7.2
作者：
Massad, L. Stewart;Einstein, Mark H.;Lawson, Herschel W.
通讯作者：
Lawson, Herschel W.
DOI：
10.1136/amiajnl-2013-001613
发表时间：
2013-07
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Wagholikar KB;MacLaughlin KL;Kastner TM;Casey PM;Henry M;Greenes RA;Liu H;Chaudhry R
通讯作者：
Chaudhry R
影响因子：
3.7
作者：
Duggan, Maire A.;Nation, Jill
通讯作者：
Nation, Jill