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首页> 外文期刊>BMC Medical Informatics and Decision Making >Use of large scale EHR data to evaluate A1c utilization among sickle cell disease patients
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Use of large scale EHR data to evaluate A1c utilization among sickle cell disease patients

机译：使用大规模EHR数据来评估镰状细胞病患者的A1C利用率

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The glycated hemoglobin (A1c) test is not recommended for sickle cell disease (SCD) patients. We examine ordering patterns of diabetes-related tests for SCD patients to explore misutilization of tests among this underserved population. We used de-identified electronic health record (EHR) data in the Cerner Health Facts? (HF) data warehouse to evaluate the frequency of A1c and fructosamine tests during 2010 to 2016, for 37,151 SCD patients from 393 healthcare facilities across the United States. After excluding facilities with no A1c data, we defined three groups of facilities based on the prevalence of SCD patients with A1c test(s): adherent facilities (no SCD patients with A1c test(s)), minor non-adherent facilities, major non-adherent facilities. We determined that 11% of SCD patients (3927 patients) treated at 393 facilities in the US received orders for at least one A1c test. Of the 3927 SCD patients with an A1c test, only 89 patients (2.3%) received an order for a fructosamine test. At the minor non-adherent facilities, 5% of the SCD patients received an A1c test while 58% of the SCD patients at the least adherent facilities had at least one A1c test. Overall, the percent of A1c tests ordered for SCD patients between 2010 and 2016 remained similar. Inappropriate A1c test orders among a sickle cell population is a significant quality gap. Interventions to advance adoption of professional recommendations that advocate for alternate tests, such as fructosamine, can guide clinicians in test selection to reduce this quality gap are discussed. The informatics strategy used in this work can inform other largescale analyses of lab test utilization using de-identified EHR data.
机译：镰状细胞疾病（SCD）患者不建议糖化血红蛋白（A1C）试验。我们检查对SCD患者的糖尿病相关测试的订购模式，探讨这种不足人群中的测试的误解。我们在核心健康事实中使用了De-Idented电子健康记录（EHR）数据？ （HF）数据仓库评估2010年至2016年A1C和果糖胺试验的频率，37,151名SCD患者来自美国393个医疗机构。在不包括没有A1C数据的设施后，我们根据A1C测试的SCD患者的患病率定义了三组设施：依靠设施（没有SCD患者A1C测试），小型非追求设施，主要非 - 大型设施。我们确定11％的SCD患者（3927名患者）在美国收到的393名设施中处理了至少一个A1C测试。在3927名SCD患者的A1C试验中，只有89名患者（2.3％）收到了果糖胺试验的命令。在次要的非追求设施中，5％的SCD患者接受了A1C测试，而58％的SCD患者在最低粘附的设施中至少有一个A1C测试。总体而言，2010年和2016年之间为SCD患者订购的A1C测试的百分比保持相似。镰状细胞群体中不适当的A1C测试订单是一个重要的质量差距。干预措施提前采用专业建议，倡导替代测试，如果胺，可以指导临床医生在测试选择中，以减少这种质量差距。本作工作中使用的信息策略可以使用De-Identified EHR数据通知其他LAP测试利用率的Lab测试利用率。

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