新型电子触发器或可加速对癌症诊断的评估

  最近，刊登在国际杂志the Journal of Clinical Oncology上的一项研究成果中，来自贝勒医学院等处的科学家通过研究表示，用于搜索关键数据的电子触发器或可帮助鉴别并且减少医生对结直肠癌或前列腺癌诊断评估的延误。
  研究者Hardeep Singh教授表示，我们所用的电脑触发器可以在电子健康档案中帮助搜索大量的病人临床数据，同时也会标记出个体随后患癌症相关异常临床表现症状的延迟风险；研究者希望利用开发的这种触发新算法可以基于患者的电子健康档案来改善患者的治疗及安全性。
  文章中研究者及时地对可疑肺癌患者进行了为期30天的随访，对疑似结直肠癌患者进行60天的随访，对前列腺癌患者进行90天的随访；许多因素包括初级保健的工作量、时间压力信息超负荷以及缺少强有力的检测往往会延误对癌症患者的疾病评估。研究者指出，目前很少有新型技术或方法来有效鉴别出癌症诊断评估的延误，而电子触发器似乎可以跟随潜在的信息延误一样来扮演一种安全保护机制，从而帮助临床医生们及时应对这些延误。
  研究者在为期15个月的两项研究中招募了72名初级保健临床医师，将这些临床医师分为干扰组和控制组，在控制组中，临床医师会通过干扰组所出现的通常步骤来追踪患者可疑的表现。Singh表示，当干扰组中被计算机触发算法标记的所有病人都被认为处于风险之中时，我们就可以通过回顾这些患者的医疗记录，并且同其主治医师进行交流来证实患者疾病风险的存在。
  观察到医师存在潜在延迟通知的病人往往会进行前列腺癌和结直肠癌的及时性诊断评估，另外干预组中的大部分患者都会通过完成最终的审核来接受癌症的诊断评估。目前研究者正在
  其它设置中改进并且探索新型的触发应用程序，同时研究者还对诊断延迟进行了监测，他们希望本文研究可以帮助改善医师们对癌症诊断的时效性。
  最后研究者表示，本文中研究者指出的电子触发器可以帮助加速医生对患者癌症诊断的评估，后期研究者们还将通过更多深入的研究开发出更多新型手段来加速对患者疾病的诊断评估。（转化医学网360zhyx.com）
  以上为转化医学网原创翻译整理，转载请注明出处和链接！
转化医学网推荐的原文摘要：

Electronic Trigger-Based Intervention to Reduce Delays in Diagnostic Evaluation for Cancer: A Cluster Randomized Controlled Trial
JCO    doi: 10.1200/JCO.2015.61.1301
Daniel R. Murphy, Louis Wu, Eric J. Thomas, Samuel N. Forjuoh, Ashley N.D. Meyer and Hardeep Singh⇑
Purpose We tested whether prospective use of electronic health record-based trigger algorithms to identify patients at risk of diagnostic delays could prevent delays in diagnostic evaluation for cancer.

Methods We performed a cluster randomized controlled trial of primary care providers (PCPs) at two sites to test whether triggers that prospectively identify patients with potential delays in diagnostic evaluation for lung, colorectal, or prostate cancer can reduce time to follow-up diagnostic evaluation. Intervention steps included queries of the electronic health record repository for patients with abnormal findings and lack of associated follow-up actions, manual review of triggered records, and communication of this information to PCPs via secure e-mail and, if needed, phone calls to ensure message receipt. We compared times to diagnostic evaluation and proportions of patients followed up between intervention and control cohorts based on final review at 7 months.

Results We recruited 72 PCPs (36 in the intervention group and 36 in the control group) and applied the trigger to all patients under their care from April 20, 2011, to July 19, 2012. Of 10,673 patients with abnormal findings, the trigger flagged 1,256 patients (11.8%) as high risk for delayed diagnostic evaluation. Times to diagnostic evaluation were significantly lower in intervention patients compared with control patients flagged by the colorectal trigger (median, 104 v 200 days, respectively; n = 557; P < .001) and prostate trigger (40% received evaluation at 144 v 192 days, respectively; n = 157; P < .001) but not the lung trigger (median, 65 v 93 days, respectively; n = 19; P = .59). More intervention patients than control patients received diagnostic evaluation by final review (73.4% v 52.2%, respectively; relative risk, 1.41; 95% CI, 1.25 to 1.58).

Conclusion Electronic trigger-based interventions seem to be effective in reducing time to diagnostic evaluation of colorectal and prostate cancer as well as improving the proportion of patients who receive follow-up. Similar interventions could improve timeliness of diagnosis of other serious conditions.