目标:开发,部署,评估一个国家,基于电子健康记录(EHR)的仪表板,以支持美国退伍军人事务医疗保健系统(VA)中生物和有针对性的合成疾病改善剂(b/tsDMARD)的安全处方。
方法:我们提取并显示乙型肝炎(HBV),丙型肝炎(HCV),以及使用PowerBI(Microsoft)从EHR为b/tsDMARD用户提供的结核病(TB)筛查数据,并于2022年将仪表板部署到美国各地的VA设施;我们在部署后观察了44周的设施。
方法:我们检查了医护人员参与的仪表板与完成所有筛查的患者百分比之间的关联(HBV,HCV,和TB)在设施级别使用中断的时间序列。根据会话的频率,设施分为高参与度和低参与度/无参与度类别。我们对仪表板部署前和部署后的完整筛选中的变化进行了建模。
方法:所有VA设施均符合纳入条件;排除的设施参与仪表板设计或有<20名患者接受b/tsDMARDs。使用PowerBI审核日志数据捕获来自设施人员的会话计数。每周根据通过仪表板本身提取的EHR数据评估结果。
结果:共包括117个设施(为41,224名退伍军人规定的b/tsDMARDs提供服务)。在部署仪表板之前,在所有设施中,61.5%的患者完成了所有筛查,在研究期间,这一比例提高到66.3%。最大的改善(15个百分点,60.3%-75.3%)发生在高参与度的设施中(高参与度和低参与度/无参与度组之间的干预后结果差异为每周0.17个百分点(pp),95%置信区间(0.04pp,0.30pp);p=0.01)。
结论:我们观察到,在与仪表板高度接触的设施中,潜伏性感染的筛查有了显著改善,与会议较少的人相比。
OBJECTIVE: To develop, deploy, and evaluate a national, electronic health record (EHR)-based dashboard to support safe prescribing of biologic and targeted synthetic disease-modifying agents (b/tsDMARDs) in the United States Veterans Affairs Healthcare System (VA).
METHODS: We extracted and displayed hepatitis B (HBV), hepatitis C (HCV), and tuberculosis (TB) screening data from the EHR for users of b/tsDMARDs using PowerBI (Microsoft) and deployed the dashboard to VA facilities across the United States in 2022; we observed facilities for 44 weeks post-deployment.
METHODS: We examined the association between dashboard engagement by healthcare personnel and the percentage of patients with all screenings complete (HBV, HCV, and TB) at the facility level using an interrupted time series. Based on frequency of sessions, facilities were grouped into high- and low/none-engagement categories. We modeled changes in complete screening pre- and post-deployment of the dashboard.
METHODS: All VA facilities were eligible for inclusion; excluded facilities participated in design of the dashboard or had <20 patients receiving b/tsDMARDs. Session counts from facility personnel were captured using PowerBI audit log data. Outcomes were assessed weekly based on EHR data extracted via the dashboard itself.
RESULTS: Totally 117 facilities (serving a total of 41,224 Veterans prescribed b/tsDMARDs) were included. Before dashboard deployment, across all facilities, 61.5% of patients had all screenings complete, which improved to 66.3% over the course of the study period. The largest improvement (15 percentage points, 60.3%-75.3%) occurred among facilities with high engagement (post-intervention difference in outcome between high and low/none-engagement groups was 0.17 percentage points (pp) per week, 95% confidence interval (0.04 pp, 0.30 pp); p = 0.01).
CONCLUSIONS: We observed significant improvements in screening for latent infections among facilities with high engagement with the dashboard, compared with those with fewer sessions.