背景:该分析评估了提交给剧院医疗数据存储(TMDS)和可报告医疗事件(RME)系统的前向部署狂犬病咨询委员会的DD2341表格(动物咬伤潜在狂犬病暴露报告)的潜在报告差异(RME),以确定可以导致改进最佳实践的报告差距,以确保将潜在狂犬病暴露后预防(PEP)记录到服务成员的电子记录(SM)中。
方法:该项目比较了向Arifjan营地提交的服务成员动物暴露DD2341报告的数量,科威特狂犬病咨询委员会将从2018年1月1日至2019年12月31日在同一前方部署地点的战区内治疗电子记录记录在TMDS和RME数据库中。记录包括部署到美国中央司令部(USCENTCOM)责任区六个国家的现役和预备役SM。分析比较了一些人口统计信息,潜在狂犬病暴露类型(例如,无论是咬伤还是刮伤),用人类狂犬病免疫球蛋白(HRIG)对狂犬病进行PEP,人类狂犬病疫苗(HRV),或两者在报告系统之间。
结果:来自TMDS数据记录的PEP记录比来自剧院书面报告的记录少44条。电子记录数据显示85编码狂犬病暴露诊断。22人接受了HRV,没有接受HRIG,而4人接受了PEP的HRIG和HRV。在接受狂犬病PEP的26个SM中,只有7个具有与电子记录相关的确认RME。有116份SM动物暴露书面报告,有70个报告PEP。有41条记录表明SM作为PEP的一部分接受了HRIG和HRV,而29例报告显示患者仅接受HRVPEP。在接收HRIG的41个SM中,32的暴露来自猫的划痕或咬伤。指定HRIG的7条记录已用于治疗,但在该地点不可用;因此,HRV是唯一可用的治疗方法。书面报告中指出的未接受狂犬病PEP的最常见原因是未根据动物暴露的风险类别指示治疗。
结论:这项研究首次将电子病历数据与手术室报告中的狂犬病暴露进行了比较。分析表明,在USCENTCOM战区生成的某些书面形式未输入SM军事卫生系统电子病历,这表明,在部署的环境中,电子病历可能比狂犬病计划监测的手术室报告更不敏感。TMDS和RME数据库中狂犬病PEP的电子病历报告不足。根据武装部队健康监测司的指南和病例定义,狂犬病PEP是RME。需要将DD2341更好地集成到电子病历系统中。
BACKGROUND: This analysis evaluates potential reporting discrepancies of the DD2341 Form (Report of Animal Bite-Potential Rabies Exposure) submitted to a forward-deployed Rabies Advisory Board to the Theater Medical Data Store (TMDS) and Reportable Medical Event (RME) systems to identify reporting gaps that can lead to improved best practices that ensure documentation of Post Exposure Prophylaxis (PEP) of potential rabies exposures into service members (SMs) electronic medical records.
METHODS: The project compares the number of Service Member animal exposure DD2341
reports submitted to the Camp Arifjan, Kuwait Rabies Advisory Board to in-theater treatment electronic records at the same forward deployed locations from January 1, 2018 to December 31, 2019 recorded in the TMDS and RME databases. Records included active duty and reserve SM deployed to six countries in the United States Central Command (USCENTCOM) area of responsibility. The analysis compared some demographic information, type of potential rabies exposure (e.g., whether a bite or scratch), and PEP to rabies with Human Rabies Immune Globulin (HRIG), Human Rabies Vaccine (HRV), or both between the reporting systems.
RESULTS: There were 44 fewer records of PEP from the TMDS data records than reported from in theater written
reports. Electronic record data showed 85 coded rabies exposure diagnoses. Twenty-two received HRV and no HRIG, while four received HRIG and HRV for PEP. Only seven of the 26 SM receiving rabies PEP had a confirmed RME associated with the electronic record. There were 116 SM animal exposure written
reports, with 70 reporting PEP. There were 41 records indicating the SM received HRIG and HRV as part of PEP, while 29
reports indicated that the patient received only HRV PEP. Of the 41 SM receiving HRIG, 32 of the exposures were from cat scratches or bites. Seven records specified HRIG was indicated for treatment but not available at the location; therefore, HRV was the only treatment available. The most common reason indicated on the written report for not receiving rabies PEP was that treatment was not indicated based on the risk category of animal exposure.
CONCLUSIONS: This study is the first to compare the electronic medical record data to in theater reports for potential rabies exposure in a theater of operations. The analysis suggests that some written forms generated in the USCENTCOM theater are not entered into SM Military Health System electronic medical records, indicating that electronic medical records may be a less sensitive method than in-theatre reports for rabies program surveillance in a deployed setting. There is under-reporting in electronic medical records of rabies PEP in both TMDS and RME databases. Rabies PEP is an RME according to the Armed Forces Health Surveillance Division guidelines and
case definitions. There needs to be better integration of the DD2341 into the electronic medical records system.