Impact of an Electronic Medical Record Quality Improvement Intervention on Helicobacter pylori Treatment and Eradication Rates in a U.S. Hospital System

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2025-04-16 DOI:10.1111/hel.70034

Shivani Kastuar, Samanthika Devalaraju, Juan Gomez Cifuentes, Hashem B. El-Serag, Mimi C. Tan

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Abstract

Background

In this pre- and post-intervention quality improvement (QI) study, the impact of an electronic medical record (EMR) order set for Helicobacter pylori treatment was assessed. We evaluated changes in optimal treatment regimen usage, eradication testing, and successful eradication rates based on the intervention.

Materials and Methods

Data were collected from patients within the Harris Health System (Houston, TX) with H. pylori infection. The pre-intervention cohort included patients with a positive H. pylori test from January to February 2022. An EMR order set for H. pylori treatment implemented in May 2022 included optimal treatment recommendations using local antibiotic resistance patterns and testing for eradication post-treatment. Comparisons of proportions with optimal treatment and eradication rates between the pre-intervention cohort, an early post-intervention group (June–July 2022), and a late post-intervention group (November–December 2022) were evaluated using chi-square tests.

Results

We identified 295 patients in the pre-intervention, 414 patients in the early post-intervention, and 320 patients in the late post-intervention cohorts. There was an increase in proportions of optimal treatment (bismuth-quadruple, clarithromycin-quadruple, or rifabutin-triple therapy with a proton pump inhibitor for 14 days) between the pre- and early post-intervention groups from 26.4% to 39.7% (p < 0.01) with a further increase in the late post-intervention group to 85.3% (p < 0.01). The proportion of post-treatment eradication testing within 24 months increased from 56% in the pre-intervention cohort to 65.8% in the early post-intervention cohort (p = 0.01) and 64.9% in the late post-intervention cohort (p = 0.03). In patients with post-treatment eradication testing, there was an increase in successful eradication from 80.6% in the pre-intervention cohort to 88.9% in the early post-intervention cohort (p = 0.03) and 82.6% in the late post-intervention cohort (p = 0.66).

Conclusions

An EMR order set for H. pylori treatment and eradication testing significantly increased rates of using optimal, evidence-based treatment, post-treatment eradication testing, and confirmed eradication of H. pylori infection.

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电子病历质量改进干预对美国医院系统幽门螺杆菌治疗和根除率的影响

背景在这项干预前和干预后质量改善（QI）研究中，评估了电子病历（EMR）对幽门螺杆菌治疗的影响。我们评估了基于干预的最佳治疗方案使用、根除试验和成功根除率的变化。资料和方法收集Harris卫生系统（Houston， TX）幽门螺旋杆菌感染患者的数据。干预前队列包括2022年1月至2月幽门螺杆菌检测阳性的患者。2022年5月实施的幽门螺杆菌治疗EMR命令包括使用当地抗生素耐药性模式和治疗后根除检测的最佳治疗建议。采用卡方检验对干预前队列、干预后早期组（2022年6月至7月）和干预后晚期组（2022年11月至12月）的最佳治疗比例和根除率进行比较。结果我们确定了干预前295例患者，干预后早期414例患者，干预后晚期320例患者。在干预前和干预后早期组中，最佳治疗（四联铋、四联克拉霉素或利法布汀三联治疗联合质子泵抑制剂14天）的比例从26.4%增加到39.7% (p < 0.01)，干预后晚期组进一步增加到85.3% （p < 0.01）。治疗后24个月内根除检测的比例从干预前的56%上升到干预后早期的65.8% （p = 0.01）和干预后晚期的64.9% （p = 0.03）。在治疗后进行根除试验的患者中，成功根除率从干预前的80.6%增加到干预后早期的88.9% (p = 0.03)，干预后晚期的82.6% （p = 0.66）。结论设置幽门螺杆菌治疗和根除检测的EMR单可显著提高最佳循证治疗、治疗后根除检测和幽门螺杆菌感染确诊根除率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.