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Use of National Electronic Health Record (EHR) Data Warehouse to Identify Inappropriate HbA1c Orders for Sickle Cell Disease Patients

机译：使用国家电子健康记录（EHR）数据仓库来识别镰状细胞病患者的不适当的HbA1c订单

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摘要

The glycated Hemoglobin (HbA1c) test is one of the most important diagnostic and prognostic strategies for monitoring diabetes. However, the clinical utility of this test is questionable for sickle cell disease patients, who are homozygous for a variant hemoglobin gene (HBB). While there have been analyses from individual provider organizations, no prior national level analysis of the HbA1c ordering practice for sickle cell disease patients has been performed. A national level assessment could serve as a baseline to evaluate this quality concern in individual health care settings. The main objective of this study was to evaluate the frequency of the inappropriate HbA1c test orders and the prevalence of the more appropriate fructosamine test orders as an alternative to HbA1c test, nationally and at Truman Medical Center (TMC) in Kansas City, MO. We analyzed de-identified, HIPAA compliant, electronic health record (EHR) data in the Cerner Health Facts (TM) (HF) data warehouse. We identified the frequency of inappropriate orders of HbA1c tests by comparing the 526 Sickle cell patients in TMC with 36,625 sickle cell patients from 393 national facilities in the data warehouse. The linear unbiased percentages estimated from the Generalized Linear Mixed Model (GLMM) was used to rank the TMC with other national hospitals based on the percentage of sickle cell patients with inappropriate HbA1c test. TMC had a significantly higher percentage of sickle cell patients with HbA1c tests when compared to the national hospital cohort (32% versus 11%). The results showed that TMC ranks in the bottom 25% quartile of the 393 qualifying facilities with respect to inappropriate HbA1c orders. Interestingly, TMC sickle cell patients were ten-fold more likely to have at least one fructosamine encounter when compared to the sickle cell patients in the other 10 national hospitals which had fructosamine encounters (11% versus 1%). However, there was still a significantly higher number of sickle cell disease patients in TMC than in other national hospitals who had only HbA1c tests (24% versus 10%). These findings indicate that inappropriate HbA1c orders in sickle cell patients is a potential quality concern at TMC which can be addressed with sustainable interventions so that overtreatment or under-treatment of the diabetic condition in sickle cell patients are avoided.
机译：糖化血红蛋白（HbA1c）测试是监测糖尿病最重要的诊断和预后策略之一。但是，对于变型血红蛋白基因（HBB）纯合的镰状细胞病患者，该测试的临床实用性值得怀疑。虽然已经有个别提供者组织进行了分析，但尚未对镰状细胞病患者的HbA1c订购实践进行过国家一级的分析。国家水平的评估可以作为评估个人医疗机构中质量问题的基准。这项研究的主要目的是评估全国范围内以及密苏里州堪萨斯州杜鲁门医学中心（TMC）的不当HbA1c测试命令的频率以及更合适的果糖胺测试命令的流行，以替代HbA1c测试。我们在Cerner Health Facts（TM）（HF）数据仓库中分析了符合HIPAA要求的已取消标识的电子健康记录（EHR）数据。通过将526名TMC镰状细胞患者与来自数据仓库中393个国家机构的36,625例镰状细胞患者进行比较，我们确定了HbA1c测试不当订购的频率。广义线性混合模型（GLMM）估计的线性无偏百分比用于根据HbA1c测试不当的镰状细胞患者的百分比对其他国家医院的TMC进行排名。与国家医院队列相比，TMC接受HbA1c检测的镰状细胞患者百分比显着更高（32％对11％）。结果显示，就不适当的HbA1c订单而言，TMC在393个合格设施中排在最后25％的四分位数之内。有趣的是，与其他10家遇到果糖胺事件的国立医院的镰刀状细胞患者相比较，TMC镰状细胞病患者遇到至少1种果糖胺的可能性高出十倍（11％比1％）。但是，与仅接受HbA1c检测的其他国立医院相比，TMC中的镰状细胞病患者仍然要多得多（24％比10％）。这些发现表明，在镰状细胞病患者中不合适的HbA1c订单是TMC潜在的质量问题，可以通过可持续的干预措施解决，从而避免对镰状细胞病患者的糖尿病状况进行过度治疗或治疗不足。

著录项

  • 作者

    Sivasankar, Shivani.;

  • 作者单位

    University of Missouri - Kansas City.;

  • 授予单位 University of Missouri - Kansas City.;
  • 学科 Bioinformatics.
  • 学位 M.S.
  • 年度 2018
  • 页码 57 p.
  • 总页数 57
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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