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Area of Science:

  • Public Health
  • Health Equity
  • Adolescent Medicine

Background:

  • Minoritized adolescents experience higher rates of chlamydia (CT) and gonorrhea (GC) testing compared to white peers.
  • Interventions are crucial to address and mitigate bias in healthcare delivery for these populations.
  • Existing disparities necessitate innovative solutions within healthcare systems.

Purpose of the Study:

  • To evaluate if electronic health record (EHR)-integrated clinical decision support (CDS) can reduce racial and ethnic disparities in CT/GC testing among adolescents.
  • To compare the effectiveness of targeted vs. universally offered CT/GC testing strategies.
  • To assess the impact of CDS on differential testing based on race and ethnicity.

Main Methods:

  • A secondary analysis of a prospective pragmatic trial involving 6 pediatric emergency departments.
  • Comparison of targeted CT/GC testing (CDS based on risk assessment) versus universally offered testing (CDS triggered by patient desire).
  • Logistic regression analysis to compare racial and ethnic differences in testing rates between the two phases.

Main Results:

  • During the baseline, minoritized groups, particularly non-Hispanic Black patients, were significantly more likely to be tested for CT/GC than non-Hispanic white patients (aOR=2.10).
  • Targeted CDS did not alter these disparities, with differential testing persisting (P=.35).
  • Universally offered CT/GC testing integrated with EHR-CDS successfully mitigated racial and ethnic differences, leading to similar testing proportions across groups (P=.01).

Conclusions:

  • Universally offered CT/GC testing, facilitated by EHR-embedded CDS, effectively reduces racial and ethnic disparities in adolescent testing within pediatric emergency departments.
  • This strategy promotes more equitable sexual health screening for all adolescents, regardless of race or ethnicity.
  • Implementing universally offered testing with CDS is a viable approach to address healthcare bias in STI screening.