Effect of Implementing a Dashboard With or Without a Best Practice Alert on HLA-B*58:01 Testing Rates Among...

Area of Science:

• Pharmacogenomics
• Clinical Decision Support Systems
• Health Informatics

Background:

• The American College of Rheumatology recommends HLA-B*58:01 allele testing prior to allopurinol initiation, especially in Asian and Black/African American populations due to higher risks of severe hypersensitivity reactions.
• Despite recommendations, HLA-B*58:01 testing rates remain suboptimal in many clinical settings.
• Low testing rates can lead to increased morbidity and healthcare costs associated with severe adverse drug reactions.

Purpose of the Study:

• To evaluate the effectiveness of a clinician-facing dashboard, with and without a Best Practice Alert (BPA), in increasing HLA-B*58:01 allele testing rates.
• To assess the impact of these interventions on guideline adherence for allopurinol prescriptions at Veterans Health Administration (VA) medical centers.
• To compare the efficacy of a dashboard alone versus a dashboard combined with a BPA.

Main Methods:

• A clinician-facing dashboard displaying HLA-B*58:01 testing results was implemented in October 2022 at two VA medical centers.
• A synchronous Best Practice Alert (BPA) was added in January 2023 at one site, prompting providers about recommended testing for eligible patients.
• Electronic health record data were used to compare the proportion of patients receiving allopurinol who underwent HLA-B*58:01 testing before and after intervention implementation.

Main Results:

• The percentage of eligible patients tested for HLA-B*58:01 increased from 8.8% to 35.5% at the site with both dashboard and BPA, compared to an increase from 2.1% to 4.5% at the dashboard-only site (p<0.0001).
• The cumulative percentage of prescribers ordering HLA-B*58:01 testing rose from 11.7% to 46.8% with the dashboard and BPA, versus 6.9% to 10.8% with the dashboard alone (p<0.0001).
• The combined dashboard and BPA intervention demonstrated a significantly greater improvement in testing rates.

Conclusions:

• The implementation of a clinician-facing dashboard coupled with a simple text-based Best Practice Alert (BPA) significantly enhanced the proportion of patients undergoing guideline-recommended HLA-B*58:01 testing.
• This combined intervention proved more effective than a dashboard implementation alone in improving adherence to pharmacogenetic testing guidelines.
• Clinical decision support tools, particularly those incorporating alerts, can effectively address gaps in guideline-recommended genetic testing for high-risk medications.