Format

Send to

Choose Destination
See comment in PubMed Commons below
Chest. 2011 Jul;140(1):198-204. doi: 10.1378/chest.10-1658. Epub 2010 Dec 30.

Impact of a clinical decision support system in an electronic health record to enhance detection of α₁-antitrypsin deficiency.

Author information

1
Internal Medicine and Information Technology Division, Cleveland, OH.
2
Pulmonary Function Laboratory, the Respiratory Institute, Cleveland, OH.
3
Quantitative Health Services, Cleveland, OH.
4
Education Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH; Cleveland Clinic Respiratory Therapy, Cleveland Clinic, Cleveland, OH. Electronic address: stollej@ccf.org.

Abstract

BACKGROUND:

Because α(1)-antitrypsin deficiency (AATD) is underrecognized, strategies to enhance guideline-based diagnostic testing are warranted.

METHODS:

We studied the impact of issuing a guideline-based alert within an electronic health record (EHR) to test for AATD on the rate of testing for and detection of AATD. For patients at the Cleveland Clinic whose physician-ordered pulmonary function test results showed airflow obstruction, the rates of testing for and detection of AATD were determined during a baseline (prealert) period and again after implementing the alert.

RESULTS:

During the baseline period, among 979 eligible subjects, 4.7% were tested; 8.9% of those who had phenotype testing performed were found to have AATD (serum levels < 100 mg/dL), of whom 3.2% had the PI*ZZ genotype. After the alert, among the 624 eligible subjects, the rate of testing increased severalfold (15.1%, P < .001), though neither the rate of detecting AATD (5.3%) nor PI*ZZ (2.6%) differed from the rates during the baseline period. Having an alternate diagnosis (other than asthma) that could explain airflow obstruction (eg, congestive heart failure, sarcoidosis, Langerhans cell histiocytosis) was associated with a lower rate of testing (P = .041), while carrying a diagnosis of asthma tended to increase the testing frequency (P = .15). Multivariate analysis showed that younger age and a smoking history were associated with being tested.

CONCLUSIONS:

Issuing an alert within an EHR was associated with a severalfold increase in the frequency of testing for α(1)-antitrypsin without a higher rate of diagnosing severe AATD. While the lack of more frequent diagnosis of AATD may reflect a high rate of baseline detection, these results prompt consideration of additional strategies to enhance detection of AATD.

PMID:
21193532
DOI:
10.1378/chest.10-1658
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center