scholarly journals Impact of an electronic medical record best practice alert on expedited partner therapy for chlamydia infection and reinfection

2021 ◽  
Author(s):  
Sarah J Willis ◽  
Heather Elder ◽  
Noelle M Cocoros ◽  
Myfanwy Callahan ◽  
Katherine K Hsu ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Best Practice ◽  
Prevalence Ratio ◽  
Interrupted Time Series ◽  
Chlamydia Infection ◽  
Expedited Partner Therapy ◽  
Best Practice Alert ◽  
The Impact ◽  
To Receive

Abstract Background Atrius Health implemented a best practice alert (BPA) to encourage clinicians to provide expedited partner therapy (EPT) in October 2014. We assessed the impact of the BPA on EPT provision and chlamydial reinfection; and the impact of EPT on testing for chlamydia reinfection and reinfection rates. Methods We included patients ≥15 years with ≥1 positive chlamydia test between January 2013-March 2019. Tests-of-reinfection were defined as chlamydia tests 28-120 days after initial infection and corresponding positive results were considered evidence of reinfection. We used interrupted time series analyses to identify changes in 1) frequency of EPT; 2) tests-of-reinfection; 3) reinfections after the BPA was released. Log-binomial regression models, with GEE methods, assessed associations between EPT and tests-of-reinfection, and EPT and reinfection. Results Among 7,267 chlamydia infections, EPT was given to 1,475 (20%) patients. EPT frequency increased from 15% to 22% of infections between January 2013-September 2014 (β =0.003, p=0.03). After the BPA was released, EPT frequency declined to 19% of infections by March 2019 (β =-0.004, p=0.008). On average, 35% of chlamydia infections received a test-of-reinfection and 7% were reinfected; there were no significant changes in these percentages after BPA implementation. Patients given EPT were more likely to receive tests-of-reinfection (prevalence ratio (PR) 1.09, 95% CI: 1.01-1.16) but without change in reinfections (PR 0.88, 95% CI: 0.66-1.17). Conclusions BPAs in electronic medical record systems may not be effective at increasing EPT prescribing and decreasing chlamydial reinfection. However, patients given EPT were more likely to receive a test of chlamydia reinfection.

Implementation of Best Practice Alert in an Electronic Medical Record to Limit Lower-Value Inpatient Echocardiograms

2018 ◽  
Vol 122 (9) ◽  
pp. 1574-1577 ◽  
Author(s):  
Adam Fleddermann ◽  
Steve Jones ◽  
Sarah James ◽  
Kevin F. Kennedy ◽  
Michael L. Main ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Best Practice ◽  
Best Practice Alert

scholarly journals The impact of an electronic medical record nudge on reducing testing for hospital-onset Clostridioides difficile infection

2020 ◽  
Vol 41 (4) ◽  
pp. 411-417 ◽  
Author(s):  
Jessica R. Howard-Anderson ◽  
Mary Elizabeth Sexton ◽  
Chad Robichaux ◽  
Zanthia Wiley ◽  
Jay B. Varkey ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Level Change ◽  
Order Rate ◽  
Clostridioides Difficile ◽  
Stool Softener ◽  
Clostridioides Difficile Infection ◽  
The Impact

AbstractObjective:To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).Design:An interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours.Setting:Four hospitals in an academic healthcare network.Patients:All patients with a C. difficile order after hospital day 3.Intervention:Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order (“nudge”).Results:Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73–0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98–1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61–1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93–0.97).Conclusion:An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.

scholarly journals The role of a best practice alert in the electronic medical record in reducing repetitive lab tests

2018 ◽  
Vol Volume 10 ◽  
pp. 611-618 ◽  
Author(s):  
Harini Bejjanki ◽  
Lazarus Mramba ◽  
Stacy Beal ◽  
Nila Radhakrishnan ◽  
Rohit Bishnoi ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Best Practice ◽  
Best Practice Alert

scholarly journals Adult Learning Principles and Peer Delivery Improve Satisfaction of Electronic Medical Record Onboarding Education

ACI Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e114-e118
Author(s):  
Joanna Lawrence ◽  
Sharman Tan Tanny ◽  
Victoria Heaton ◽  
Lauren Andrew
Keyword(s):  
Adult Learning ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Junior Doctors ◽  
Free Text ◽  
Organizational Safety ◽  
Adult Learning Principles ◽  
Learning Practices ◽  
Learning Principles ◽  
The Impact

Abstract Objectives Given the importance of onboarding education in ensuring the safety and efficiency of medical users in the electronic medical record (EMR), we re-designed our EMR curriculum to incorporate adult learning principles, informed and delivered by peers. We aimed to evaluate the impact of these changes based on their satisfaction with the training. Methods A single site pre- and post-observational study measured satisfaction scores (four questions) from junior doctors attending EMR onboarding education in 2018 (pre-implementation) compared with 2019 (post-implementation). An additional four questions were asked in the post-implementation survey. All questions employed a Likert scale (1–5) with an opportunity for free-text. Raw data were used to calculate averages, standard deviations and the student t-test was used to compare the two cohorts where applicable. Results There were a total of 98 respondents in 2018 (pre-implementation) and 119 in 2019 (post-implementation). Satisfaction increased from 3.8/5 to 4.5/5 (p < 0.0001) following implementation of a peer-delivered curriculum in line with adult learning practices. The highest-rated factors were being taught by other doctors (4.9/5) and doctors having the appropriate knowledge to deliver training (4.9/5). Ninety-two percent of junior doctors were motivated to engage in further EMR education and 90% felt classroom support was adequate. Conclusion EMR onboarding education for medical users is a critical ingredient to organizational safety and efficiency. An improvement in satisfaction ratings by junior doctors was demonstrated after significant re-design of the curriculum was informed and delivered by peers, in line with adult learning principles.

scholarly journals Length of Initial Prescription at Hospital Discharge and Long-Term Medication Adherence for Elderly, Post-Myocardial Infarction Patients: Protocol for an Interrupted Time Series Study (Preprint)

2020 ◽  
Author(s):  
J D Schwalm ◽  
Noah M Ivers ◽  
Zachary Bouck ◽  
Monica Taljaard ◽  
Madhu K Natarajan ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Usual Care ◽  
Intervention Group ◽  
Interrupted Time Series ◽  
Interventional Study ◽  
Cardiac Medication ◽  
The Impact ◽  
To Receive ◽  
Discharge Prescription

BACKGROUND Based on high-quality evidence, guidelines recommend the long-term use of secondary prevention medications post-myocardial infarction (MI) to avoid recurrent cardiovascular events and death. Unfortunately, discontinuation of recommended medications post-MI is common. Observational evidence suggests that prescriptions covering a longer duration at discharge from hospital are associated with greater long-term medication adherence. The following is a proposal for the first interventional study to evaluate the impact of longer prescription duration at discharge post-MI on long-term medication adherence. OBJECTIVE The overarching goal of this study is to reduce morbidity and mortality among post-MI patients through improved long-term cardiac medication adherence. The specific objectives include the following. First, we will assess whether long-term cardiac medication adherence improves among elderly, post-MI patients following the implementation of (1) standardized discharge prescription forms with 90-day prescriptions and 3 repeats for recommended cardiac medication classes, in combination with education and (2) education alone compared to (3) usual care. Second, we will assess the cost implications of prolonged initial discharge prescriptions compared with usual care. Third, we will compare clinical outcomes between longer (&gt;60 days) versus shorter prescription durations. Fourth, we will collect baseline information to inform a multicenter interventional study. METHODS We will conduct a quasiexperimental, interrupted time series design to evaluate the impact of a multifaceted intervention to implement longer duration prescriptions versus usual care on long-term cardiac medication adherence among post-MI patients. Intervention groups and their corresponding settings include: (1) intervention group 1: 1 cardiac center and 1 noncardiac hospital allocated to receive standardized discharge prescription forms supporting the dispensation of 90 days’ worth of cardiac medications with 3 repeats, coupled with education; (2) intervention group 2: 4 sites (including 1 cardiac center) allocated to receive education only; and (3) control group: all remaining hospitals within the province that did not receive an intervention (ie, usual care). Administrative databases will be used to measure all outcomes. Adherence to 4 classes of cardiac medications — statins, beta blockers, angiotensin system inhibitors, and secondary antiplatelets (ie, prasugrel, clopidogrel, or ticagrelor) — will be assessed. RESULTS Enrollment began in September 2017, and results are expected to be analyzed in late 2020. CONCLUSIONS The results have the potential to redefine best practices regarding discharge prescribing policies for patients post-MI. A policy of standardized maximum-duration prescriptions at the time of discharge post-MI is a simple intervention that has the potential to significantly improve long-term medication adherence, thus decreasing cardiac morbidity and mortality. If effective, this low-cost intervention to implement longer duration prescriptions post-MI could be easily scaled. CLINICALTRIAL ClinicalTrials.gov NCT03257579; https://clinicaltrials.gov/ct2/show/NCT03257579 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18981

scholarly journals United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

2018 ◽  
Vol 103 (6) ◽  
pp. 837-843 ◽  
Author(s):  
Alastair K Denniston ◽  
Aaron Y Lee ◽  
Cecilia S Lee ◽  
David P Crabb ◽  
Clare Bailey ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Real World ◽  
Eye Disease ◽  
Inclusion Criteria ◽  
Data Set ◽  
Diabetic Eye Disease ◽  
The Impact

AimTo assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service.MethodsThis is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main  outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment.Results79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58).ConclusionsThis large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.

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