Mitigation of Racial and Ethnic Differences in Chlamydia and Gonorrhea Testing

Minoritized adolescents have higher proportions of chlamydia (CT) and gonorrhea (GC) testing compared with their white peers. Interventions to mitigate bias in care delivery are needed. The objective of this study was to determine whether electronic health record (EHR)-integrated clinical decision support (CDS) mitigates differential testing of patients based on their race and ethnicity.

This planned secondary analysis of a prospective pragmatic parent trial at 6 pediatric emergency departments compared targeted vs universally offered CT/GC testing in patients aged 15-21 years. Adolescents completed a tablet-based sexual health screen to determine CT/GC risk. During the targeted phase, CDS was based on the CT/GC risk assessment. During the universally offered phase, a patient's desire for CT/GC testing triggered EHR-embedded CDS. Racial and ethnic differences with respect to CT/GC testing were compared between phases using a logistic regression model.

During the baseline phase, almost all racial and ethnic groups were more likely to have CT/GC testing compared with non-Hispanic white patients, with the largest difference in non-Hispanic Black patients (adjusted odds ratio, 2.10; 95% CI, 1.83-2.41). Despite the CDS, there was no change in testing during the targeted phase, meaning differential CT/GC testing in minoritized groups persisted (P = .35). However, CDS did mitigate racial and ethnic differences in the universally offered phase, meaning all racial and ethnic groups had CT/GC testing at a similar proportion (P = .01).

Universally offered CT/GC testing using an EHR-embedded CDS can mitigate racial and ethnic differences in CT/GC testing among adolescents in a pediatric emergency department.