scholarly journals Retraction of: Electronic Clinical Decision Support Intervention to Increase Hepatitis C Screening and Linkage to Care Among Baby Boomers in Urban Safety Net Health Systems, by Armstrong, et al. (Popul Health Manag; 2019 Oct 8. doi: 10.1089/pop.2019.0105. [Epub ahead of print]

2020 ◽  
Vol 23 (1) ◽  
pp. 104-104
Keyword(s):  
Decision Support ◽  
Hepatitis C ◽  
Baby Boomers ◽  
Linkage To Care ◽  
Clinical Decision ◽  
Safety Net ◽  
Support Intervention ◽  
Decision Support Intervention ◽  
Urban Safety ◽  
Electronic Clinical Decision Support

scholarly journals 90. Deimplementation: Use of Electronic Clinical Decision Support to Reduce Unnecessary Erythrocyte Sedimentation Rate (ESR) Ordering

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S160-S160
Author(s):  
Yasaman Fatemi ◽  
Julianne Burns ◽  
Tracey Polsky ◽  
Ellen Nord ◽  
Susan Coffin
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Inpatient Setting ◽  
Support Intervention ◽  
Concurrent Control ◽  
Decision Support Intervention ◽  
Ed Visits ◽  
Basic Metabolic Panel ◽  
Electronic Clinical Decision Support

Abstract Background In recent years, several de-implementation initiatives have focused on diagnostic testing. One such initiative, the Choosing Wisely campaign, recommends against routine use of erythrocyte sedimentation rate (ESR) for assessment of acute undiagnosed inflammation or infection. With the development of newer biomarkers of inflammation, particularly C-reactive protein (CRP), there is a decreasing role for ESR in screening for acute-onset conditions; however, ESR continues to be commonly ordered. Methods We examined ESR and CRP ordering practices at the Children’s Hospital of Philadelphia (CHOP) from July 2019 to July 2020 and found that 80% of ESR orders were placed concurrently with an order for CRP. We aimed to reduce ESR ordering by 20% at CHOP by using electronic clinical decision support in the form of embedded order guidance for ESR orders placed in the Emergency Department (ED) and inpatient setting. We examined the effect of the clinical decision support by assessing ESR ordering rate, defined by ESR orders per monthly patient days for the inpatient setting and ESR orders per monthly ED visits for the ED setting. We then examined differences in ordering rates using a quasi-experimental model with a concurrent control (basic metabolic panel). ESR Electronic Clinical Decision Support Intervention Inpatient and ED versions of the embedded electronic clinical decision support for ESR orders. Results Prior to implementation of the electronic decision support intervention, the median monthly rate of ESR orders was 13.6 per 1000 patient days and 70.3 per 1000 ED visits. During the initial month after implementation, we found that ESR ordering was 12.5 in inpatient and 46.4 in ED, reflecting decreased rates of ordering. The median monthly rate of basic metabolic panel orders (concurrent control) was 194.5 per 1000 patient days and 110.0 per 1000 ED visits. This was unchanged after intervention. Conclusion We conclude that electronic clinical decision support is a potentially effective deimplementation method for improving diagnostic test utilization, even with non-disease specific testing such as inflammatory markers. However, continued post-implementation data monitoring and analysis is needed to determine if this is a true difference and sustainable trend. Disclosures All Authors: No reported disclosures

scholarly journals P036: A clinical decision support intervention to increase usage of probenecid in the ED

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S90-S90
Author(s):  
S. Dowling ◽  
E. Lang ◽  
D. Wang ◽  
T. Rich
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Soft Tissue ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Soft Tissue Infections ◽  
Post Intervention ◽  
Support Intervention ◽  
Intervention Phase ◽  
Decision Support Intervention

Introduction: In certain circumstances, skin and soft tissue infections are managed with intravenous (IV) antibiotics. In our center, patients initiated on outpatient IV antibiotics are followed up by a home parental therapy program the following day. A significant number of these patients require a repeat visit to the ED because of clinic hours. Probenecid is a drug that can prolong the half-life of certain antibiotics (such as cefazolin) and can therefore avoid a repeat ED visit, reducing health care costs and improve ED capacity. Our goal was to increase probenecid usage in the ED in order to optimize management of skin and soft tissue infections (SSTI) in the ED. The primary outcome was to compare the usage of probenecid in the pre and post-intervention phase. Secondary outcomes were to compare revisit rates between patients receiving cefazolin alone vs cefazolin + probenecid. Methods: Using administrative data merged with Computerized Physician Order Entry (CPOE), we extracted data 90 days pre- and 90 post-intervention (February 11, 2015 to August 11, 2015). The setting for the study is an urban center (4 adult ED’s with an annual census of over 320,000 visits per year). Our CPOE system is fully integrated into the ED patient care. The multi-faceted intervention involved modifying all relevant SSTI order sets in the CPOE system to link any cefazolin order with an order for probenecid. Physicians and nurses were provided with a 1 page summary of probenecid (indications, contra-indications, pharmacology), as well as decision support with the CPOE. Any patients who were receiving outpatient cefazolin therapy were included in the study. Results: Our analysis included 2512 patients (1148 and 1364 patients in the pre/post phases) who received cefazolin in the ED and were discharged during the 180 day period. Baseline variables (gender, age, % admitted) and ED visits were similar in both phases. In the pre-intervention phase 30.2% of patients received probenecid and in the post-intervention phase 43.0%, for a net increase of 12.8% (p=<0.0001). Patients who received probenecid had a 2.2% (11.4% vs 13.6%, p=0.014) lower re-visit rate in the following 72H. Conclusion: We have implemented a CPOE based clinical decision support intervention that demonstrated significant increase in probenecid usage by emergency physician and resulted in a decrease in ED revisits. This intervention would result in health care cost-savings.

Clinical Decision Support Intervention and Time to Imaging in Older Patients with Traumatic Brain Injury

2020 ◽  
Vol 231 (3) ◽  
pp. 361-367.e2
Author(s):  
Arthur S. Nguyen ◽  
Simon Yang ◽  
Brian V. Thielen ◽  
Kristina Techar ◽  
Regina M. Lorenzo ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Decision Support ◽  
Brain Injury ◽  
Clinical Decision Support ◽  
Older Patients ◽  
Clinical Decision ◽  
Support Intervention ◽  
Decision Support Intervention

scholarly journals Relationship Between Hepatitis C Clinical Testing Site and Linkage to Care

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Sabrina A. Assoumou ◽  
Wei Huang ◽  
C. Robert Horsburgh ◽  
Mari-Lynn Drainoni ◽  
Benjamin P. Linas
Keyword(s):  
Hepatitis C ◽  
Private Insurance ◽  
Linkage To Care ◽  
Safety Net ◽  
Hcv Rna ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Control And Prevention ◽  
Multivariable Regression ◽  
Testing Site

Abstract Background.  The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing of the population born between 1945 and 1965 with follow-up RNA testing for those with reactive serology. To increase the rate of diagnosis, testing may be considered in settings other than outpatient clinics (OC), such as inpatient wards (IP) or emergency department (ED). Methods.  We used electronic medical records to create a retrospective cohort with reactive HCV serology between 2005 and 2010 at an urban safety net hospital. We determined factors associated with linkage to HCV care as measured by HCV RNA testing, and we evaluated the rate of linkage to care according to diagnosis location (OC, IP, or ED). Results.  Individuals, 37 828, were tested and 5885 (16%) were reactive. Seropositivity was similar across all sites. Of the 4466 patients who met inclusion criteria, 3400 (76%) were diagnosed in the OC, whereas 967 (22%) and 99 (2%) were tested in the IP and the ED, respectively. A total of 2135 (48%) underwent HCV RNA testing. Using multivariable regression modeling, the following factors were independently associated with HCV RNA testing: diagnosis in the OC (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.42–1.90); age at diagnosis in decades (OR, 0.98; 95% CI, 0.98–0.99); private insurance (OR, 1.17; 95% CI, 1.01–1.34); and ≥10 visits after diagnosis (OR, 2.15; 95% CI, 1.89–2.44). Conclusion.  There is an opportunity to increase HCV diagnosis by testing in sites other than the OC, but this opportunity needs to be coupled with robust initiatives to improve linkage to care.

scholarly journals Routine Screening and Linkage to Care for Hepatitis C Virus in an Urban Safety-Net Health System, 2017-2019

2020 ◽  
pp. 003335492096917
Author(s):  
Bijou R. Hunt ◽  
Christopher Ahmed ◽  
Kimberly Ramirez-Mercado ◽  
Christopher Patron ◽  
Nancy R. Glick
Keyword(s):  
Risk Factors ◽  
Hepatitis C ◽  
Health System ◽  
Patient Navigation ◽  
Linkage To Care ◽  
Safety Net ◽  
Test Results ◽  
Number Of Patients ◽  
Urban Safety ◽  
Hcv Screening

Objective Hepatitis C virus (HCV) is a major threat to public health in the United States. We describe and evaluate an HCV screening and linkage-to-care program, including emergency department, inpatient, and outpatient settings, in an urban safety-net health system in Chicago. Methods Sinai Health System implemented a universal HCV screening program in September 2016 that offered patient navigation services (ie, linkage to care) to patients with a positive result for HCV on an RNA test. We collected data from February 1, 2017, through January 31, 2019, on patient demographic characteristics, risk factors, and various outcomes (eg, number of patients screened, test results, proportions of new diagnoses, number of patients eligible for patient navigation services, and proportion of patients who attended their first medical appointment). We also examined outcomes by patients’ knowledge of infection. Results Of 21 018 people screened for HCV, 6% (1318/21 018) had positive test results for HCV antibody, 68% (878/1293) of whom had positive HCV RNA test results. Of these 878 patients, 68% were born during 1945-1965, 68% were male, 65% were Black, 19% were Latino, 55% were newly diagnosed, and 64% were eligible for patient navigation services. Risk factors included past or current drug use (53%), unemployment (30%), and ever incarcerated (21%). Of 562 patients eligible for navigation services, 281 (50%) were navigated to imaging services, and 203 (72%) patients who completed imaging attended their first medical appointment. Conclusion Patient navigation played a critical role in linkage success, but securing stable, long-term financial support for patient navigators is a challenge.

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