通过电子健康记录链接的最佳实践警报,提高患有出血性中风的患者的并发症管理:一项前/后研究
Savvina Prapiadou1,2,3,4, Reinier W P Tack2,3,4,5, Tamara N Kimball1,2,3,4
1Department of Neurology Brigham and Women's Hospital Boston MA USA.
Journal of the American Heart Association
|December 3, 2025
概括
一个电子健康记录干预改善了对血流性中风幸存者的高脂血症和糖尿病的评估. 然而,这并没有导致对异常水平的治疗加剧.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 医疗信息学 医疗信息学
背景情况:
- 血流性中风幸存者往往没有管理的大脑血管风险因素,如高脂血症和糖尿病.
- 这些并发症的低最佳管理增加了中风复发和主要心血管不良事件的风险.
- 有效的治疗方法存在,但在住院期间的系统评估仍然不足.
研究的目的:
- 评估基于电子健康记录 (EHR) 的干预措施是否有助于对出血性中风住院患者的高脂血症和糖尿病的评估和管理.
- 评估EHR最佳实践警报对订购低密度脂蛋白胆固醇 (LDL-C) 和糖化血红蛋白 (HbA1c) 水平的影响.
主要方法:
- 前性队列研究比较历史 (n=314) 和干预 (n=296) 后出血性中风组.
- 干预使用了EHR最佳实践警报来提示LDL-C和HbA1c测试.
- 统计分析包括格雷测试,多变量Fine和Grey模型,以及千平方/费舍尔精确测试.
主要成果:
- 该干预显著增加了HbA1c评估的累积发病率 (57.9%至75.8%) 和LDL-C评估 (55.3%至72.4%).
- 在干预期间,在两项评估中,观察到分发危险增加了61% (LDL-C HR: 1.61,HbA1c HR: 1.61).
- 尽管评估率有所提高,但对异常HbA1c或LDL-C水平的治疗强化没有发现显著变化.
结论:
- 基于EHR的干预成功地提高了住院出血性中风患者关键并发症的评估率.
- 需要进一步的研究来确定这些增强的评估是否转化为改善长期患者管理和结果.
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