AJPM focus最新文献_第3页

Editorial Board and Journal Information 编辑委员会和期刊信息

AJPM focus

Pub Date : 2024-12-01 DOI: 10.1016/S2773-0654(24)00116-0

引用次数: 0

2023 Author Acknowledgment and Articles of the Year 2023年度作者致谢及文章

AJPM focus

Pub Date : 2024-12-01 DOI: 10.1016/S2773-0654(24)00117-2

引用次数: 0

E-Cigarette Use and Use of Evidence-Based Smoking Cessation Methods Among American Indian Cigarette Smokers: A Cross-Sectional Analysis

AJPM focus

Pub Date : 2024-11-26 DOI: 10.1016/j.focus.2024.100302

Ashley L. Comiford DrPH , Dorothy A. Rhoades MD, MPH , Justin D. Dvorak PhD , Kai Ding PhD , Noah Collins , Alexandra L. Blair , Mark P. Doescher MD, MSPH

Introduction

Tobacco use is the leading cause of death in the U.S., and American Indian/Alaska Native people have high rates of tobacco-related diseases. Although the U.S. Food and Drug Administration–approved products and evidence-based methods exist for smoking cessation, people who smoke might use E-cigarettes as cessation aids. Whether E-cigarette use is associated with the use of evidence-based methods is unknown, particularly among American Indian/Alaska Native individuals.

Methods

Using survey data collected in 2016 from 289 adult American Indian people who smoke and who reported a previous cessation attempt, the authors conducted multivariate logistic regression analyses to assess the associations between E-cigarette use and evidence-based cessation methods. Analyses were performed in 2023.

Results

Individuals who currently or formerly used E-cigarettes were significantly more likely to report using nicotine replacement therapy during their last quit attempt than those who did not use E-cigarettes (current versus never AOR=4.6, 95% CI=1.9, 11.9; past versus never AOR=4.6, 95% CI=2.2, 9.8; p<0.001). Current and former E-cigarette use was significantly associated with prescription use in the unadjusted analysis but lost significance in the adjusted analysis (current versus never AOR=3.1, 95% CI=1.0, 10.5; past versus never AOR=2.7, 95% CI=1.1, 7.9; p>0.05). Individuals with current or former use of E-cigarettes were significantly less likely than individuals who never used E-cigarettes to use the cold turkey method (unassisted cessation) (current versus never AOR=0.3, 95% CI=0.2, 0.6; past versus never AOR=0.3, 95% CI=0.1, 0.7; p<0.01).

Conclusions

These results suggest that persons who use E-cigarettes are more likely than individuals who do not use E-cigarettes to previously have tried nicotine replacement therapy but less likely to use the cold turkey method. A larger study is needed to determine whether individuals who use E-cigarettes are also more likely to have tried prescription medication for smoking cessation. Whether E-cigarette use impedes or encourages the use of evidence-based cessation methods is unknown.

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引用次数: 0

Disparities in COVID-19 Vaccine Uptake Among Pregnant People in a Diverse Urban Population With High Vaccine Acceptance

AJPM focus

Pub Date : 2024-11-22 DOI: 10.1016/j.focus.2024.100303

Christine A. Blauvelt MD , Maura Jones Pullins MD , Stephanie L. Gaw MD, PhD

Introduction

This study's objective was to compare COVID-19 vaccination rates between pregnant individuals in San Francisco and the city's similarly aged population and to identify the factors associated with vaccine uptake in the pregnant population.

Methods

This was a retrospective cohort study of all patients delivering at 2 hospitals in San Francisco from March 15, 2021, to October 15, 2021. Reference COVID-19 vaccination rates for San Francisco were obtained from the California Immunization Registry. The primary outcome was completion of a COVID-19 vaccine series among pregnant individuals compared with that in the San Francisco general population aged 18–45 years. Secondary outcomes included factors associated with COVID-19 vaccination among pregnant people.

Results

Of 2,294 pregnant individuals, 1,181 (51.5%) completed a COVID-19 vaccine series by delivery. Pregnant individuals were less likely to be vaccinated than the San Francisco population throughout the study period. Factors associated with lower vaccination rates in pregnant individuals included public insurance (AOR=0.21, 95% CI=0.16, 0.27), younger age (AOR=0.74, 95% CI=0.64, 0.86), English language preference (AOR=0.58, 95% CI=0.42, 0.80), and self-identified Black (AOR=0.26, 95% CI=0.17, 0.40) (ref: White), Hispanic (AOR=0.61, 95% CI=0.46, 0.81), or other (AOR=0.50, 95% CI=0.36, 0.68) race or ethnicity.

Conclusions

COVID-19 vaccination coverage among pregnant people in San Francisco lagged behind that of the city's similarly aged population, particularly among those with public insurance and of non-White race. Despite locally high vaccine acceptance, additional efforts are needed to address barriers and reduce disparities in COVID-19 vaccination within the pregnant population.

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引用次数: 0

Assessing the Association Between Respiratory Symptoms and Nicotine and Cannabis Use Through Traditional and E-Product Devices in the U.S. 评估美国呼吸系统症状与通过传统和电子产品设备使用尼古丁和大麻之间的关系

AJPM focus

Pub Date : 2024-10-22 DOI: 10.1016/j.focus.2024.100291

Phil Veliz PhD , John Jardine MA , Luisa Kcomt PhD , Carol Boyd PhD , Sean Esteban McCabe PhD , Rebecca Evans-Polce PhD

Introduction

The aim of this study was to assess the association between past 30-day cigarette smoking, nicotine use with an e-product device (e.g., vape), cannabis smoking, cannabis use with an e-product device, and other forms of cannabis use and past-year respiratory symptoms in a nationally representative sample of people aged ≥12 years in the U.S. during 2021.

Methods

Data from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study, a national probability sample of adolescents (aged 12–17 years; n=5,652) and adults (aged ≥18 years; n=30,516), were used. Logistic regression was used to assess the association of past 30-day cigarette smoking, nicotine use with an e-product, cannabis smoking, cannabis use with an e-product, and other forms of cannabis use with past-year respiratory symptoms (a past-year respiratory symptom index was constructed and ranged from 0 to 9; an index of 2+ was flagged as having functionally important respiratory impairment).

Results

The odds of a past-year respiratory index score of 2+ was greater among respondents who indicated either past 30-day cigarette or cannabis smoking than among respondents who did not use any nicotine or cannabis during the past 30 days. Past 30-day nicotine and cannabis use with an e-product device was not associated with a respiratory symptom index of 2+. The combination of past 30-day cigarette smoking and cannabis smoking had one of the strongest associations with experiencing a respiratory index score of 2+ among dual users of nicotine and cannabis.

Conclusions

Past 30-day cigarette smoking and cannabis smoking were associated with higher odds of functionally important respiratory impairment. In addition, this study provides robust evidence regarding the potential respiratory harms of single or dual nicotine and cannabis smoking as it relates to respiratory health.

导言本研究旨在评估过去 30 天内吸烟、使用电子产品装置（如 vape）吸食尼古丁、吸食大麻、使用电子产品装置吸食大麻以及其他形式的大麻使用与上一年呼吸道症状之间的关联、方法使用了《烟草与健康人口评估研究》第 6 波（2021 年）的数据，该研究是一项全国性的青少年（12-17 岁；n=5,652）和成年人（≥18 岁；n=30,516）概率抽样调查。采用逻辑回归法评估过去 30 天内吸烟、使用尼古丁和电子产品、吸食大麻、使用大麻和电子产品以及其他形式的大麻使用与过去一年呼吸系统症状的关系（构建了过去一年呼吸系统症状指数，范围为 0 至 9；指数为 2+ 时，表示存在重要的呼吸系统功能障碍）。结果与过去 30 天内未吸食任何尼古丁或大麻的受访者相比，过去 30 天内吸食尼古丁或大麻的受访者过去一年呼吸系统指数达到 2+ 分的几率更大。过去 30 天内使用电子产品装置吸食尼古丁和大麻与呼吸道症状指数 2+ 无关。在尼古丁和大麻的双重使用者中，过去 30 天吸烟和吸食大麻的组合与呼吸系统指数达到 2+ 分值的关系最为密切。此外，这项研究还提供了有力的证据，说明单一或双重吸食尼古丁和大麻对呼吸系统健康的潜在危害。

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引用次数: 0

Factors Associated With Influenza Vaccination in a National Veteran Cohort 全国退伍军人队列中与流感疫苗接种有关的因素

AJPM focus

Pub Date : 2024-10-21 DOI: 10.1016/j.focus.2024.100290

Alissa S. Chen MD , Melissa M. Farmer PhD , Ling Han MD, PhD, MS , Tessa Runels MPH , Brett Bade MD , Kristina Crothers MD , Lori A. Bastian MD, MPH , Isabel S. Bazan MD , Bevanne A. Bean-Mayberry MD, MHS , Cynthia A. Brandt MD, MPH , Kathleen M. Akgün MD, MS

Introduction

Only 53% of American adults receive influenza vaccination, and disparities in vaccination exist among particular racial and ethnic groups. This study determines how race, ethnicity, sex, and rurality are associated with influenza vaccination adherence in a national Veteran Health Affairs Administration cohort.

Methods

The authors examined differences in documented influenza vaccinations for the 2019–2020 influenza season among Veteran Health Affairs Administration patients in a retrospective cohort study using Veteran Health Affairs Administration administrative electronic health record data. The author used logistic regression to model receipt of influenza vaccination in association with race, ethnicity, sex, and rurality while controlling for clinical diagnoses, demographics, and ambulatory care utilization. The authors also stratified the models by sex and rurality.

Results

Among 5,943,918 veterans, 48.6% received influenza vaccination. Unadjusted comparisons showed that those who were vaccinated were more likely to be White, to be of male sex, and to be older. Similar proportions of unvaccinated and unvaccinated veterans were from rural settings. In adjusted models, Black race was most strongly associated with decreased vaccination (AOR=0.69; 95% CI=0.69, 0.70), and American Indian/Alaskan Native race also had reduced odds of vaccination (AOR=0.94; 95% CI=0.92, 0.95) compared with White race. Female veterans had increased odds of vaccination (AOR=1.20; 95% CI=1.19, 1.20) compared with men. Rurality (AOR=0.97; 95% CI=0.96, 0.97) was associated with a small decreased odds of vaccination compared with urban. In stratified models, Black veterans were less likely to receive influenza vaccination regardless of sex and rurality than White veterans. American Indian/Alaska Native female veterans had equal odds of vaccination as White female veterans, whereas American Indian/Alaska Native male veterans had reduced odds of vaccination compared with White male veterans.

Conclusions

During the 2019–2020 influenza season, Black and American Indian/Alaskan Native veterans had lower odds of vaccination. Despite the Veteran Health Affairs Administration's universal approach to healthcare, racial disparities still exist in preventive care.

导言只有 53% 的美国成年人接种了流感疫苗，特定种族和民族群体在接种疫苗方面存在差异。本研究确定了在全国退伍军人健康事务管理局队列中，种族、民族、性别和农村地区与坚持接种流感疫苗的关系。方法作者在一项回顾性队列研究中，利用退伍军人健康事务管理局的行政电子健康记录数据，检查了退伍军人健康事务管理局患者在 2019-2020 年流感季节接种流感疫苗的记录差异。作者使用逻辑回归法建立了接种流感疫苗与种族、民族、性别和居住地相关的模型，同时控制了临床诊断、人口统计学和非住院医疗利用率。结果在 5,943,918 名退伍军人中，48.6% 接受了流感疫苗接种。未经调整的比较显示，接种疫苗的退伍军人更可能是白人、男性和老年人。未接种疫苗和未接种疫苗的退伍军人来自农村的比例相似。在调整后的模型中，黑人种族与接种率下降的关系最为密切（AOR=0.69；95% CI=0.69，0.70），与白人种族相比，美洲印第安人/阿拉斯加原住民种族的接种率也有所下降（AOR=0.94；95% CI=0.92，0.95）。与男性相比，女性退伍军人接种疫苗的几率更高（AOR=1.20；95% CI=1.19，1.20）。与城市相比，农村（AOR=0.97；95% CI=0.96，0.97）退伍军人接种疫苗的几率略有下降。在分层模型中，与白人退伍军人相比，黑人退伍军人接种流感疫苗的几率较低，与性别和居住地无关。美国印第安人/阿拉斯加原住民女性退伍军人接种疫苗的几率与白人女性退伍军人相同，而美国印第安人/阿拉斯加原住民男性退伍军人接种疫苗的几率则低于白人男性退伍军人。结论在2019-2020年流感季节，黑人和美国印第安人/阿拉斯加原住民退伍军人接种疫苗的几率较低。尽管退伍军人健康事务管理局采取了全民医疗保健方法，但在预防保健方面仍然存在种族差异。

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引用次数: 0

Preventive Care Needs of the North Carolina Medicaid Expansion Population 北卡罗来纳州医疗补助扩展人群的预防性保健需求

AJPM focus

Pub Date : 2024-10-18 DOI: 10.1016/j.focus.2024.100289

Jennifer C. Spencer PhD , Rebecca G. Whitaker PhD , Michael P. Pignone MD, MPH

Introduction

Effective December 2023, North Carolina expanded Medicaid eligibility to cover individuals up to 138% of the Federal Poverty Level. The authors sought to understand the preventive care needs of the newly Medicaid-eligible population.

Methods

The authors conducted a repeat cross-sectional analysis using the 2016, 2018, 2020, and 2022 North Carolina Behavioral Risk Factor Surveillance Survey. The authors defined the Medicaid expansion population as those aged 18–64 years with household incomes below 138% Federal Poverty Level and reporting no current source of insurance. The authors compared with those enrolled in traditional Medicaid and all nonelderly adult North Carolinians, evaluating up-to-date use of preventive care services. Survey weights were used to estimate total unmet need.

Results

The authors estimated 294,000 individuals in the Medicaid expansion population in 2022. Preventive care use was low for the expansion population in all years. In 2022, 36.7% (27.7%–46.8%) reported having a regular source of care, 40.2% (31.1%–50%) reported a past-year wellness visit, and 45.7% (36.6%–55.2%) reported delaying needed care owing to cost. Among eligible respondents, 28.6% (13.8%–50.2%) were up to date with colorectal cancer screening (vs 49.4% [30.5%–68.4%] for traditional Medicaid and 71% [67.3%–74.4%] for all North Carolina population). It was estimated that 176,000 in the expansion population needed a wellness visit; 186,000 needed a regular care provider; and 66,000 needed 1 or more cancer screening.

Conclusions

The North Carolina Medicaid expansion population has a high number of unmet preventive care needs. North Carolina should consider approaches to improve provider capacity for those in Medicaid and promote preventive care and risk reduction for the newly enrolled expansion population.

导言自 2023 年 12 月起，北卡罗来纳州扩大了医疗补助资格，将联邦贫困线 138% 以下的个人纳入补助范围。作者试图了解新符合医疗补助资格人群的预防保健需求。方法作者利用 2016 年、2018 年、2020 年和 2022 年北卡罗来纳州行为风险因素监测调查进行了重复横截面分析。作者将医疗补助扩展人群定义为年龄在 18-64 岁之间、家庭收入低于 138% 联邦贫困线且报告当前无保险来源的人群。作者将其与参加传统医疗补助计划的人群和北卡罗来纳州所有非老年成年人进行了比较，评估了预防性保健服务的最新使用情况。作者估计，2022 年医疗补助扩展人群中将有 294,000 人。在所有年份中，医疗补助扩展人群的预防保健使用率都很低。2022 年，36.7%（27.7%-46.8%）的受访者表示有固定的医疗机构，40.2%（31.1%-50%）的受访者表示在过去一年中接受过健康检查，45.7%（36.6%-55.2%）的受访者表示因费用问题而推迟了所需的治疗。在符合条件的受访者中，28.6%（13.8%-50.2%）的受访者接受了最新的结直肠癌筛查（与之相比，传统医疗补助计划的受访者为 49.4% [30.5%-68.4%]，北卡罗来纳州所有人口的受访者为 71% [67.3%-74.4%]）。据估计，扩保人群中有 176,000 人需要接受健康检查；186,000 人需要定期接受医疗服务；66,000 人需要接受一次或多次癌症筛查。北卡罗来纳州应考虑采取各种方法，提高医疗补助计划提供者的服务能力，并促进新加入扩展计划人群的预防保健和降低风险。

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引用次数: 0

Filling the Treatment Gap: Geographic Expansion of Buprenorphine Providers Across the U.S. 填补治疗缺口：全美丁丙诺啡提供者的地域扩张

AJPM focus

Pub Date : 2024-10-16 DOI: 10.1016/j.focus.2024.100284

Suparna Das PhD , Kasimu Muhetaer MPH , Neeraj Gandotra MD , Naomi Tomoyasu PhD

Introduction

With opioid-related deaths reaching epidemic levels, gaining a better understanding of access to treatment for opioid use disorder is critical. Buprenorphine is an effective medication for the treatment of opioid addiction. The analysis is critical post–X-waiver elimination, which extended the ability to prescribe buprenorphine for the treatment of opioid use disorder to all practitioners with Drug Enforcement Agency Schedules II–V on their Drug Enforcement Agency registration. The primary purpose of the analysis was to explore the geographic patterns of substance use treatment and establish a geographic baseline to assess the removal of the X-waiver in the future.

Methods

The authors assessed the expansion of buprenorphine providers across the data from all U.S. counties up to December 31, 2022. The authors used all certified buprenorphine providers' data from the database of the buprenorphine waiver notification system. The authors used county-level population data from the U.S. Census of American Community Survey of 2021 and the Centers for Disease Prevention and Control's drug-related mortality data. The authors implemented spatial scan statistics to identify the spatial clusters using SaTScan.

Results

The results from this analysis show that Doctor of Medicine/Doctor of Osteopathic Medicine have the highest numbers of certified providers at 8,134 (65.08%) in 2018 and 14,525 (57.87%) in 2022. This analysis shows that the distribution of buprenorphine providers across the counties of the U.S. was significantly clustered. Higher clusters with RR >1 (p<0.001) were found in the states of Washington, Oregon, and Northern California and the Western borders of Montana. Similar clusters of counties with RR >1 (p<0.001) were found in the northeastern states of Maine, Vermont, and New Hampshire.

Conclusions

From this analysis, it is evident that buprenorphine-certified providers are clustered in areas of higher drug-related mortality filling a treatment gap. The elimination of the X-waiver will be a significant step toward increasing access to medication for opioid use disorder, and this analysis may be used as a geographic baseline to assess in the future.

导言随着与阿片类药物相关的死亡人数达到流行病水平，更好地了解阿片类药物使用障碍的治疗情况至关重要。丁丙诺啡是治疗阿片类药物成瘾的有效药物。X 豁免取消后，所有在缉毒机构注册表中列有 II-V 表的从业人员都可以开具治疗阿片类药物使用障碍的丁丙诺啡处方，因此这项分析至关重要。分析的主要目的是探索药物使用治疗的地域模式，并建立一个地域基线，以评估未来取消 X-豁免的情况。方法作者评估了截至 2022 年 12 月 31 日美国所有县的数据中丁丙诺啡提供者的扩展情况。作者使用了丁丙诺啡豁免通知系统数据库中所有经过认证的丁丙诺啡提供者的数据。作者使用了来自美国人口普查 2021 年美国社区调查的县级人口数据和美国疾病预防与控制中心的毒品相关死亡率数据。作者使用 SaTScan 实施了空间扫描统计，以识别空间集群。结果该分析的结果显示，医学博士/骨科医生的认证提供者数量最多，2018 年为 8,134 人（65.08%），2022 年为 14,525 人（57.87%）。该分析表明，丁丙诺啡医疗服务提供者在美国各县的分布具有明显的集群性。在华盛顿州、俄勒冈州、加利福尼亚州北部和蒙大拿州西部边界发现了RR>1（p<0.001）较高的群集。在东北部的缅因州、佛蒙特州和新罕布什尔州也发现了类似的 RR 值为 1（p<0.001）的县群。取消 "X-豁免 "将是增加阿片类药物使用障碍患者获得药物治疗机会的重要一步，本分析可用作未来评估的地理基线。

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引用次数: 0

Concordance Between DASH Diet and Coronary Artery Calcification: Results From the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Prospective Cohort Study DASH 饮食与冠状动脉钙化之间的一致性：居住在美国的南亚人动脉粥样硬化介导因素（MASALA）前瞻性队列研究结果

AJPM focus

Pub Date : 2024-10-16 DOI: 10.1016/j.focus.2024.100288

Bridget Murphy Hussain PhD, MS , Andrea L. Deierlein PhD, MPH, MS , Sameera A. Talegawkar PhD , Alka M. Kanaya MD , Joyce A. O'Connor DrPH, MA , Meghana D. Gadgil MD , Yong Lin PhD , Niyati Parekh PhD, MS

Introduction

South Asian adults are at high risk for atherosclerotic cardiovascular disease, for which coronary artery calcification is an early predictor. Adherence to the Dietary Approaches to Stop Hypertension diet is a modifiable risk factor that may mitigate the progression of coronary artery calcification and atherosclerotic cardiovascular disease.

Methods

Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, the authors calculated a Dietary Approaches to Stop Hypertension dietary score (categorized as low, moderate, and high) to examine the associations of Dietary Approaches to Stop Hypertension diet adherence with coronary artery calcification after a 5-year follow up.

Results

The authors found that participants in the high Dietary Approaches to Stop Hypertension category were 41% less likely to have coronary artery calcification score >100 (age-adjusted incidence rate ratio=0.59; 95% CI=0.36, 0.95) than those in the low category; this association was attenuated in multivariable models. Differences were observed by sex. Men in the high Dietary Approaches to Stop Hypertension category were 51% less likely to have coronary artery calcification score >100 (adjusted incidence rate ratio=0.49; 95% CI=0.26, 0.95) and experienced 0.46-fold coronary artery calcification change (fold change=0.46; 95% CI=0.18, 0.90) in multivariable models.

Conclusions

The findings indicate a relationship between Dietary Approaches to Stop Hypertension diet and early predictors of atherosclerotic cardiovascular disease risk among South Asians living in the U.S., particularly men.

导言南亚成年人是动脉粥样硬化性心血管疾病的高危人群，而冠状动脉钙化是冠状动脉钙化的早期预测指标。坚持 "膳食疗法止高血压 "饮食是一种可改变的风险因素，可减轻冠状动脉钙化和动脉粥样硬化性心血管疾病的进展。方法作者利用 "生活在美国的南亚人动脉粥样硬化介导因素 "队列中的数据，计算了 "膳食疗法止高血压 "膳食评分（分为低、中、高），以研究 "膳食疗法止高血压 "膳食坚持率与冠状动脉钙化之间的关系，并进行了为期 5 年的随访。结果作者发现，"膳食疗法止高血压 "高分参与者的冠状动脉钙化得分>100（年龄调整后发病率比=0.59；95% CI=0.36，0.95）比低分参与者低41%；这种关联在多变量模型中有所减弱。性别差异也有所体现。饮食疗法可有效控制高血压》高分级男性的冠状动脉钙化得分>100（调整后发病率比=0.49；95% CI=0.26，0.95）比低分级男性低 51%，冠状动脉钙化变化为低分级男性的 0.46 倍（折合变化=0.46；95% CI=0.26，0.95）。结论研究结果表明，在美国生活的南亚人中，"膳食疗法"（Dietary Approaches to Stop Hypertension）饮食与动脉粥样硬化性心血管疾病风险的早期预测因素之间存在关系、尤其是男性。

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引用次数: 0

Evaluation of a Diabetes Screening Clinical Decision Support Tool 糖尿病筛查临床决策支持工具的评估

AJPM focus

Pub Date : 2024-10-15 DOI: 10.1016/j.focus.2024.100287

Eva Tseng MD, MPH , Ariella Stein MPH , Nae-Yuh Wang PhD , Nestoras N. Mathioudakis MD, MHS , Hsin-Chieh Yeh PhD , Nisa M. Maruthur MD, MHS

Introduction

The authors evaluated whether an electronic health record clinical decision support system improves diabetes screening across a health system.

Methods

Study population included adults without diabetes attending a visit at 27 primary care clinics. Outcomes included the monthly screening laboratory order rate and completion rate among eligible patient visits. The authors performed logistic regression using a generalized estimating equations model and interrupted time series analysis to evaluate the change in the outcome from baseline to implementation and postimplementation periods.

Results

From the baseline to postimplementation period, screening laboratory order rates increased from 53% to 66%, and completion rates increased from 46% to 54%, respectively. The odds of laboratory order and completion increased significantly from the baseline to postimplementation period (test order: OR=3.7; 95% CI=3.4, 4.1, p<0.001; test completion: OR=2.1; 95% CI=2.0, 2.3, p<0.001). In the interrupted time series analysis, laboratory order and completion rates increased significantly from the baseline period (p<0.001 for both).

Conclusions

The authors developed and implemented a clinical decision support system alert that automatically identifies eligible patients and facilitates single-click ordering of a diabetes screening test. An easily implementable and scalable clinical decision support system alert can improve diabetes screening.

导言作者评估了电子健康记录临床决策支持系统是否能改善整个医疗系统的糖尿病筛查。方法研究对象包括在 27 家初级保健诊所就诊的无糖尿病成人。研究结果包括每月筛查实验室订单率和合格患者就诊完成率。作者使用广义估计方程模型和间断时间序列分析进行了逻辑回归，以评估从基线到实施期间和实施后结果的变化。结果从基线到实施后，筛查化验单率分别从 53% 增加到 66%，完成率从 46% 增加到 54%。从基线期到实施后，下达化验单和完成化验单的几率都有显著增加（化验单：OR=3.7；95% 置信度：0.9）：OR=3.7；95% CI=3.4，4.1，p<0.001；检验完成：OR=2.1；95% CI=2.0，2.3，p<0.001）。在间断时间序列分析中，化验单和化验完成率较基线期均有显著提高（均为 p<0.001）。结论作者开发并实施了一种临床决策支持系统警报，该系统可自动识别符合条件的患者，并为糖尿病筛查化验的单击下单提供便利。易于实施和扩展的临床决策支持系统警报可以改善糖尿病筛查。

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引用次数: 0