PDF(Pubmed)
Abstract：
BACKGROUND: The syndemic nature of gonococcal infections and HIV provides an opportunity to develop a synergistic intervention tool that could address the need for adequate treatment for gonorrhea, screen for HIV infections, and offer pre-exposure prophylaxis (PrEP) for persons who meet the criteria. By leveraging information available on electronic health records, a clinical decision support (CDS) system tool could fulfill this need and improve adherence to Centers for Disease Control and Prevention (CDC) treatment and screening guidelines for gonorrhea, HIV, and PrEP.
OBJECTIVE: The goal of this study was to translate portions of CDC treatment guidelines for gonorrhea and relevant portions of HIV screening and prescribing PrEP that stem from a diagnosis of gonorrhea as an electronic health record-based CDS intervention. We also assessed whether this CDS solution worked in real-world clinic.
METHODS: We developed 4 tools for this CDS intervention: a form for capturing sexual history information (SmartForm), rule-based alerts (best practice advisory), an enhanced sexually transmitted infection (STI) order set (SmartSet), and a documentation template (SmartText). A mixed methods pre-post design was used to measure the feasibility, use, and usability of the CDS solution. The study period was 12 weeks with a baseline patient sample of 12 weeks immediately prior to the intervention period for comparison. While the entire clinic had access to the CDS solution, we focused on a subset of clinicians who frequently engage in the screening and treatment of STIs within the clinical site under the name \"X-Clinic.\" We measured the use of the CDS solution within the population of patients who had either a confirmed gonococcal infection or an STI-related chief complaint. We conducted 4 midpoint surveys and 3 key informant interviews to quantify perception and impact of the CDS solution and solicit suggestions for potential future enhancements. The findings from qualitative data were determined using a combination of explorative and comparative analysis. Statistical analysis was conducted to compare the differences between patient populations in the baseline and intervention periods.
RESULTS: Within the X-Clinic, the CDS alerted clinicians (as a best practice advisory) in one-tenth (348/3451, 10.08%) of clinical encounters. These 348 encounters represented 300 patients; SmartForms were opened for half of these patients (157/300, 52.33%) and was completed for most for them (147/300, 89.81%). STI test orders (SmartSet) were initiated by clinical providers in half of those patients (162/300, 54%). HIV screening was performed during about half of those patient encounters (191/348, 54.89%).
CONCLUSIONS: We successfully built and implemented multiple CDC treatment and screening guidelines into a single cohesive CDS solution. The CDS solution was integrated into the clinical workflow and had a high rate of use.
OBJECTIVE: The goal of this study was to translate portions of CDC treatment guidelines for gonorrhea and relevant portions of HIV screening and prescribing PrEP that stem from a diagnosis of gonorrhea as an electronic health record-based CDS intervention. We also assessed whether this CDS solution worked in real-world clinic.
METHODS: We developed 4 tools for this CDS intervention: a form for capturing sexual history information (SmartForm), rule-based alerts (best practice advisory), an enhanced sexually transmitted infection (STI) order set (SmartSet), and a documentation template (SmartText). A mixed methods pre-post design was used to measure the feasibility, use, and usability of the CDS solution. The study period was 12 weeks with a baseline patient sample of 12 weeks immediately prior to the intervention period for comparison. While the entire clinic had access to the CDS solution, we focused on a subset of clinicians who frequently engage in the screening and treatment of STIs within the clinical site under the name \"X-Clinic.\" We measured the use of the CDS solution within the population of patients who had either a confirmed gonococcal infection or an STI-related chief complaint. We conducted 4 midpoint surveys and 3 key informant interviews to quantify perception and impact of the CDS solution and solicit suggestions for potential future enhancements. The findings from qualitative data were determined using a combination of explorative and comparative analysis. Statistical analysis was conducted to compare the differences between patient populations in the baseline and intervention periods.
RESULTS: Within the X-Clinic, the CDS alerted clinicians (as a best practice advisory) in one-tenth (348/3451, 10.08%) of clinical encounters. These 348 encounters represented 300 patients; SmartForms were opened for half of these patients (157/300, 52.33%) and was completed for most for them (147/300, 89.81%). STI test orders (SmartSet) were initiated by clinical providers in half of those patients (162/300, 54%). HIV screening was performed during about half of those patient encounters (191/348, 54.89%).
CONCLUSIONS: We successfully built and implemented multiple CDC treatment and screening guidelines into a single cohesive CDS solution. The CDS solution was integrated into the clinical workflow and had a high rate of use.
摘要：
背景：淋球菌感染和艾滋病毒的共病性质为开发一种协同干预工具提供了机会，该工具可以满足淋病充分治疗的需求。筛查艾滋病毒感染，并为符合标准的人提供暴露前预防（PrEP）。通过利用电子健康记录上的可用信息，临床决策支持（CDS）系统工具可以满足这一需求，并提高对疾病控制和预防中心（CDC）淋病治疗和筛查指南的依从性，艾滋病毒,和PrEP。
目的：这项研究的目的是翻译CDC淋病治疗指南的部分以及HIV筛查和处方PrEP的相关部分，这些部分源于将淋病诊断为基于电子健康记录的CDS干预措施。我们还评估了这种CDS解决方案在现实世界的诊所是否有效。
方法：我们为这种CDS干预开发了4种工具：一种获取性史信息的形式（SmartForm），基于规则的警报（最佳实践建议），增强的性传播感染(STI)订单集(SmartSet)，和文档模板(SmartText)。采用混合方法进行后前设计来衡量可行性，使用,以及CDS解决方案的可用性。研究期为12周,在干预期前12周的基线患者样品用于比较。虽然整个诊所都能使用CDS解决方案，我们重点研究了一部分临床医生,他们经常在临床中心以"X-Clinic"为名从事性传播感染筛查和治疗.“我们测量了已确诊淋球菌感染或与性传播感染相关的主诉患者人群中CDS溶液的使用情况。我们进行了4次中点调查和3次关键线人访谈，以量化CDS解决方案的感知和影响，并征求对未来潜在增强的建议。定性数据的结果是使用探索性和比较性分析相结合的方法确定的。进行统计分析以比较基线和干预期患者人群之间的差异。
结果：在X诊所内，在十分之一(348/3451,10.08%)的临床遭遇中,CDS提醒临床医生(作为最佳实践咨询).这348次相遇代表300名患者；这些患者中有一半（157/300，52.33％）打开了SmartForms，大多数患者（147/300，89.81％）完成了SmartForms。STI测试订单（SmartSet）由临床提供者在这些患者中的一半（162/300，54％）发起。在这些患者中，约有一半（191/348，54.89％）进行了HIV筛查。
结论：我们成功地将多个CDC治疗和筛查指南构建并实施到单一的粘性CDS解决方案中。CDS解决方案被整合到临床工作流程中并且具有高使用率。
目的：这项研究的目的是翻译CDC淋病治疗指南的部分以及HIV筛查和处方PrEP的相关部分，这些部分源于将淋病诊断为基于电子健康记录的CDS干预措施。我们还评估了这种CDS解决方案在现实世界的诊所是否有效。
方法：我们为这种CDS干预开发了4种工具：一种获取性史信息的形式（SmartForm），基于规则的警报（最佳实践建议），增强的性传播感染(STI)订单集(SmartSet)，和文档模板(SmartText)。采用混合方法进行后前设计来衡量可行性，使用,以及CDS解决方案的可用性。研究期为12周,在干预期前12周的基线患者样品用于比较。虽然整个诊所都能使用CDS解决方案，我们重点研究了一部分临床医生,他们经常在临床中心以"X-Clinic"为名从事性传播感染筛查和治疗.“我们测量了已确诊淋球菌感染或与性传播感染相关的主诉患者人群中CDS溶液的使用情况。我们进行了4次中点调查和3次关键线人访谈，以量化CDS解决方案的感知和影响，并征求对未来潜在增强的建议。定性数据的结果是使用探索性和比较性分析相结合的方法确定的。进行统计分析以比较基线和干预期患者人群之间的差异。
结果：在X诊所内，在十分之一(348/3451,10.08%)的临床遭遇中,CDS提醒临床医生(作为最佳实践咨询).这348次相遇代表300名患者；这些患者中有一半（157/300，52.33％）打开了SmartForms，大多数患者（147/300，89.81％）完成了SmartForms。STI测试订单（SmartSet）由临床提供者在这些患者中的一半（162/300，54％）发起。在这些患者中，约有一半（191/348，54.89％）进行了HIV筛查。
结论：我们成功地将多个CDC治疗和筛查指南构建并实施到单一的粘性CDS解决方案中。CDS解决方案被整合到临床工作流程中并且具有高使用率。
