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Evaluation of Point-of-Care Decision Support for Adult Acne Treatment by Primary Care Clinicians.
JAMA Dermatology ( IF 11.5 ) Pub Date : 2020-05-01 , DOI: 10.1001/jamadermatol.2020.0135 David G Li 1 , Ashley B Pournamdari 1, 2 , Kristina J Liu 1 , Karl Laskowski 3, 4 , Cara Joyce 5 , Arash Mostaghimi 1
JAMA Dermatology ( IF 11.5 ) Pub Date : 2020-05-01 , DOI: 10.1001/jamadermatol.2020.0135 David G Li 1 , Ashley B Pournamdari 1, 2 , Kristina J Liu 1 , Karl Laskowski 3, 4 , Cara Joyce 5 , Arash Mostaghimi 1
Affiliation
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Importance
Acne is a common reason for referral to dermatologists from primary care clinicians. We previously modeled the impact of algorithm-based acne care in reducing dermatology referrals, missed appointments, and treatment delays.
Objective
To prospectively evaluate the downstream outcomes following a real-time, algorithm-based electronic decision-support tool on the treatment of patients referred for acne.
Design, Setting, and Participants
This prospective cohort study included 260 treatment-naive patients referred to a dermatologist for the chief concern of acne, as well as the referring primary care clinicians, at 33 primary care sites affiliated with Brigham and Women's Hospital from March 2017 to March 2018.
Interventions
We developed and implemented a decision-support tool into the electronic medical record system at an academic medical center. The algorithm identified patients referred to a dermatologist who had not previously been treated for acne and offered guideline-based recommendations for treatment via a real-time notification.
Main Outcomes and Measures
Treatment modification by referring clinicians.
Results
Of 260 patients referred for acne, 209 (80.4%) were women, 146 (56.1%) were non-Hispanic white, and 236 (90.8%) listed English as the preferred language. Patients had a median (quartile 1-quartile 3) age of 28.8 years (24.4-35.1 years) and 185 of 260 had private insurance (71.1%). In total, the algorithm was associated with cancellation of the initial referral in 35 of 260 (13.5%) instances and treatment initiation by the referring clinician in 51 of 260 (19.6%) instances.
Conclusions and Relevance
This decision-support algorithm was associated with a modest reduction in rates of acne-related referrals to dermatologists, and an increased likelihood of treatment initiation by the referring clinician.
中文翻译：
初级保健医生对成人痤疮治疗的护理点决策支持的评估。
痤疮的重要性是从初级保健临床医生那里转介到皮肤科医生的常见原因。我们以前模拟了基于算法的痤疮护理在减少皮肤科转诊，错过约会和治疗延迟方面的影响。目的通过实时，基于算法的电子决策支持工具对痤疮转诊患者的治疗进行前瞻性评估，以评估下游疗效。设计，设置和参加者这项前瞻性队列研究包括2017年3月以来在Brigham和妇女医院附属的33个初级保健场所中，有260名初治患者转介至皮肤科医生，主要治疗痤疮，以及转诊的初级保健临床医生至2018年3月。干预措施我们在学术医学中心的电子病历系统中开发并实施了决策支持工具。该算法确定了转诊至皮肤科医生的患者，这些患者之前未接受过痤疮的治疗，并通过实时通知提供了基于指南的治疗建议。主要结果和措施推荐临床医生进行治疗修改。结果260名痤疮患者中，有209名（80.4％）为女性，有146名（56.1％）为非西班牙裔白人，有236名（90.8％）将英语列为首选语言。患者的中位年龄（四分位数1-四分位数3）为28.8岁（24.4-35.1岁），260名患者中有185名拥有私人保险（占71.1％）。总体而言，该算法与260中的35中取消初始推荐有关（13。260例（19.6％）的病例中，有51例发生了5％的病例，并且转诊的临床医生开始了治疗。结论与相关性该决策支持算法与痤疮相关皮肤科医生转诊率的适度降低以及转诊临床医生开始治疗的可能性增加有关。
更新日期：2020-05-01
中文翻译：
初级保健医生对成人痤疮治疗的护理点决策支持的评估。
痤疮的重要性是从初级保健临床医生那里转介到皮肤科医生的常见原因。我们以前模拟了基于算法的痤疮护理在减少皮肤科转诊，错过约会和治疗延迟方面的影响。目的通过实时，基于算法的电子决策支持工具对痤疮转诊患者的治疗进行前瞻性评估，以评估下游疗效。设计，设置和参加者这项前瞻性队列研究包括2017年3月以来在Brigham和妇女医院附属的33个初级保健场所中，有260名初治患者转介至皮肤科医生，主要治疗痤疮，以及转诊的初级保健临床医生至2018年3月。干预措施我们在学术医学中心的电子病历系统中开发并实施了决策支持工具。该算法确定了转诊至皮肤科医生的患者，这些患者之前未接受过痤疮的治疗，并通过实时通知提供了基于指南的治疗建议。主要结果和措施推荐临床医生进行治疗修改。结果260名痤疮患者中，有209名（80.4％）为女性，有146名（56.1％）为非西班牙裔白人，有236名（90.8％）将英语列为首选语言。患者的中位年龄（四分位数1-四分位数3）为28.8岁（24.4-35.1岁），260名患者中有185名拥有私人保险（占71.1％）。总体而言，该算法与260中的35中取消初始推荐有关（13。260例（19.6％）的病例中，有51例发生了5％的病例，并且转诊的临床医生开始了治疗。结论与相关性该决策支持算法与痤疮相关皮肤科医生转诊率的适度降低以及转诊临床医生开始治疗的可能性增加有关。
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