Kelsey O. Cole PA-C, MMSc, Melissa B. Weimer DO, MCR, Kaicheng Wang MD, MPH, David A. Fiellin MD, Anisha J. Advani MD, Nidhi Shah MD, Christopher T. Zemaitis PharmD, MBA, BCPS, Deborah J. Rhodes MD
{"title":"电子集成临床路径对医院开始使用酒精使用障碍药物和随后的医院使用的影响","authors":"Kelsey O. Cole PA-C, MMSc, Melissa B. Weimer DO, MCR, Kaicheng Wang MD, MPH, David A. Fiellin MD, Anisha J. Advani MD, Nidhi Shah MD, Christopher T. Zemaitis PharmD, MBA, BCPS, Deborah J. Rhodes MD","doi":"10.1002/jhm.70049","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Medications for alcohol use disorder (MAUD) are underutilized and multiple barriers and disparities in treatment initiation have been identified. Effective hospital-based strategies to promote MAUD use are not well-defined.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To determine whether an electronic health record (EHR)-integrated clinical pathway increases MAUD initiation.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We conducted a prospective observational cohort study with consecutive adult inpatients diagnosed with alcohol use disorder (AUD) and withdrawal requiring treatment who were admitted to a health system comprising a mix of community and tertiary academic medical centers. The impact of voluntary use of an AUD EHR-integrated clinical pathway on MAUD initiation (main outcome) and ED return or readmission for any cause within 30 days of discharge (secondary outcomes) was evaluated.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 2630 inpatient medicine encounters, the pathway was utilized in 17.8%. Pathway utilization was associated with 4.31 (confidence interval [CI]: 3.10–5.99, <i>p</i> < .001) increased odds of MAUD initiation as compared with encounters without pathway utilization (31% vs. 15.4%). There were no differences in rates of 30-day ED returns (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.35–1.62; <i>p</i> = .47) or 30-day readmissions (OR: 1.19; 95% CI: 0.80–1.76; <i>p</i> = .40) and no differences in MAUD initiation by race or ethnicity when the pathway was utilized versus not utilized.</p>\n </section>\n \n <section>\n \n <h3> Conclusions and Relevance</h3>\n \n <p>Utilization of an EHR-integrated clinical pathway for individuals with AUD significantly increased MAUD initiation at hospital discharge. 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Rhodes MD\",\"doi\":\"10.1002/jhm.70049\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Medications for alcohol use disorder (MAUD) are underutilized and multiple barriers and disparities in treatment initiation have been identified. Effective hospital-based strategies to promote MAUD use are not well-defined.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To determine whether an electronic health record (EHR)-integrated clinical pathway increases MAUD initiation.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We conducted a prospective observational cohort study with consecutive adult inpatients diagnosed with alcohol use disorder (AUD) and withdrawal requiring treatment who were admitted to a health system comprising a mix of community and tertiary academic medical centers. 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Impact of an electronically-integrated clinical pathway on hospital initiation of medications for alcohol use disorder and subsequent hospital utilization
Background
Medications for alcohol use disorder (MAUD) are underutilized and multiple barriers and disparities in treatment initiation have been identified. Effective hospital-based strategies to promote MAUD use are not well-defined.
Objective
To determine whether an electronic health record (EHR)-integrated clinical pathway increases MAUD initiation.
Methods
We conducted a prospective observational cohort study with consecutive adult inpatients diagnosed with alcohol use disorder (AUD) and withdrawal requiring treatment who were admitted to a health system comprising a mix of community and tertiary academic medical centers. The impact of voluntary use of an AUD EHR-integrated clinical pathway on MAUD initiation (main outcome) and ED return or readmission for any cause within 30 days of discharge (secondary outcomes) was evaluated.
Results
Among 2630 inpatient medicine encounters, the pathway was utilized in 17.8%. Pathway utilization was associated with 4.31 (confidence interval [CI]: 3.10–5.99, p < .001) increased odds of MAUD initiation as compared with encounters without pathway utilization (31% vs. 15.4%). There were no differences in rates of 30-day ED returns (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.35–1.62; p = .47) or 30-day readmissions (OR: 1.19; 95% CI: 0.80–1.76; p = .40) and no differences in MAUD initiation by race or ethnicity when the pathway was utilized versus not utilized.
Conclusions and Relevance
Utilization of an EHR-integrated clinical pathway for individuals with AUD significantly increased MAUD initiation at hospital discharge. These findings support the use of an EHR-integrated clinical pathway as an implementation tool for overcoming barriers to MAUD initiation and may be a generalizable strategy for increasing low rates of MAUD prescribing for patients with AUD.
期刊介绍：
JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children.
Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.
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