Brief reportsUsing computerized clinical decision support for latent tuberculosis infection screening
Section snippets
Background
Tuberculosis (TB) remains a major disease in the United States and in the world. Given the estimated 2 million deaths annually, tuberculosis is the second leading infectious cause of death worldwide behind human immunodeficiency virus (HIV).1 Among U.S.-born people, there was a 62% decrease in the number of reported TB cases from 1992 to 2002. In contrast, there was a 5% increase in the reported TB cases among foreign-born people during the same time period.2 With over 50% of new cases
Methods
A computerized clinical decision support system at two outpatient primary care clinics in Denver CO was used to assess screening for latent tuberculosis infection following the CDC guideline: “Targeted Tuberculin Testing and Treatment of Latent Tuberculosis.”4 In collaboration with the Public Health Practice Program Office of the CDC and Siemens Medical Solutions USA, Inc., the CDC LTBI screening guidelines were encoded into a computerized clinical decision support system using a rules engine
Results
There were 4328 and 4135 unique adult registrations during the baseline and study phases, respectively. The average age of this group was 49 years, 64% were female, 71% were Hispanic, and 50% were uninsured. Seventy-four percent of the baseline patients (3213 of 4328), and 73% of the study period patients (3034 of 4135) had at least one LTBI risk factor that qualified for screening by CDC guidelines. Country of birth was the most common risk factor, accounting for 39% of the patients
Discussion
This study demonstrated successful application of computerized clinical decision support to adapt a national clinical guideline to local needs in a safety-net institution outpatient setting. This study is the first to demonstrate that computerized clinical decision support systems can improve screening for latent tuberculosis infection. It was surprising to observe that >70% of the patients seen in the safety-net setting had at least one CDC-defined LTBI risk factor. In addition, the high
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