Evidence map›Paper›PMID 37171858›Full record

ArticleJMIR medical informatics2023

An Electronic Dashboard to Improve Dosing of Hydroxychloroquine Within the Veterans Health Care System: Time Series Analysis.

Anna Montgomery, Gary Tarasovsky, Zara Izadi, Stephen Shiboski, Mary A Whooley, Jo Dana, Iziegbe Ehiorobo, Jennifer Barton, Lori Bennett, Lorinda Chung and 4 more

Open access · goldAbstract read
In one paragraph

Article in JMIR medical informatics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.8field-weighted citation impact, top 30% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 3 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 8 institutions in 1 country.

Anna MontgomerySan Francisco VA Medical Center, San Francisco, CA, United States.ORCID https://orcid.org/0000-0003-3333-7833
Gary TarasovskySan Francisco VA Medical Center, San Francisco, CA, United States.ORCID https://orcid.org/0009-0000-9093-6299
Zara IzadiUniversity of California San Francisco, San Francisco, CA, United States.ORCID https://orcid.org/0000-0002-1867-0905
Stephen ShiboskiUniversity of California San Francisco, San Francisco, CA, United States.ORCID https://orcid.org/0000-0002-9257-2609
Mary A WhooleySan Francisco VA Medical Center, San Francisco, CA, United States.ORCID https://orcid.org/0000-0002-5943-0078
Jo DanaSan Francisco VA Medical Center, San Francisco, CA, United States.ORCID https://orcid.org/0009-0008-1181-3978
Iziegbe EhioroboUniversity of California San Francisco, San Francisco, CA, United States.ORCID https://orcid.org/0009-0001-1306-8958
Jennifer BartonVA Portland Health Care System, Portland, OR, United States.ORCID https://orcid.org/0000-0002-6771-3465
Lori BennettRalph H Johnson VA Medical Center, Charleston, SC, United States.ORCID https://orcid.org/0000-0002-6827-7503
Lorinda ChungPalo Alto VA Medical Center, Palo Alto, CA, United States.ORCID https://orcid.org/0000-0003-0072-6939
Kimberly ReiterRaymond G Murphy VA Medical Center, Albuquerque, AZ, United States.ORCID https://orcid.org/0000-0001-8807-4095
Elizabeth WahlSeattle/Puget Sound VA Healthcare System, Seattle, WA, United States.ORCID https://orcid.org/0009-0004-4249-9492
Meera SubashUT Physicians Center for Autoimmunity, Houston, TX, United States.ORCID https://orcid.org/0000-0002-9675-301X
Gabriela SchmajukSan Francisco VA Medical Center, San Francisco, CA, United States.ORCID https://orcid.org/0000-0003-2687-5043
San Francisco VA Medical Center · USUniversity of California, San Francisco · USPalo Alto University · USRalph H. Johnson VA Medical Center · USUniversity of New Mexico · USUniversity Physicians · USVA Portland Health Care System · USVA Puget Sound Health Care System · US

Funding

Advancing Safety Process Innovation in Rheumatology (ASPIRE)R01HS028024 · AHRQ · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI YAZDANY, JINOOS · 2022 to 2025
$1.6M
Measurement Science QUERII50HX003266 · VA · VETERANS AFFAIRS MED CTR SAN FRANCISCO · PI COHEN, BETH, KALTENBACH, TONYA R · 2021 to 2021
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6 · The paper itself

Abstract

backgroundHydroxychloroquine (HCQ) is commonly used for patients with autoimmune conditions. Long-term use of HCQ can cause retinal toxicity, but this risk can be reduced if high doses are avoided.

objectiveWe developed and piloted an electronic health record-based dashboard to improve the safe prescribing of HCQ within the Veterans Health Administration (VHA). We observed pilot facilities over a 1-year period to determine whether they were able to improve the proportion of patients receiving inappropriate doses of HCQ.

methodsPatients receiving HCQ were identified from the VHA corporate data warehouse. Using PowerBI (Microsoft Corp), we constructed a dashboard to display patient identifiers and the most recent HCQ dose and weight (flagged if ≥5.2 mg/kg/day). Six VHA pilot facilities were enlisted to test the dashboard and invited to participate in monthly webinars. We performed an interrupted time series analysis using synthetic controls to assess changes in the proportion of patients receiving HCQ ≥5.2 mg/kg/day between October 2020 and November 2021.

resultsAt the start of the study period, we identified 18,525 total users of HCQ nationwide at 128 facilities in the VHA, including 1365 patients at the 6 pilot facilities. Nationwide, at baseline, 19.8% (3671/18,525) of patients were receiving high doses of HCQ. We observed significant improvements in the proportion of HCQ prescribed at doses ≥5.2 mg/kg/day among pilot facilities after the dashboard was deployed (-0.06; 95% CI -0.08 to -0.04). The difference in the postintervention linear trend for pilot versus synthetic controls was also significant (-0.06; 95% CI -0.08 to -0.05).

conclusionsThe use of an electronic health record-based dashboard reduced the proportion of patients receiving higher than recommended doses of HCQ and significantly improved performance at 6 VHA facilities. National roll-out of the dashboard will enable further improvements in the safe prescribing of HCQ.

Indexed as

audit and feedbackdashboardelectronic health recordhealth IThydroxychloroquinemedical informaticspatient safetyVeterans Health Administration

Identifiers

PMID37171858
PMCPMC10221491
OpenAlexW4327884670

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.