結核病高風險族群以臨床決策支持系統進行胸部X光檢查之成效

Using Clinical Decision Support System to Facilitate Chest X-ray Screening for Active Tuberculosis Among High Risk Patient Groups in a Tertiary Care Hospital in Taiwan

截至目前為止，結核病仍是危害我國國民健康、降低社會生產力與國際競爭力的重要傳染病。世界衛生組織也以「終止全球結核病的流行」為努力目標，期望在2035年結核病新案發生率能降至每年每10萬人口10例。而另一方面，隨著結核病新發生個案數下降以及病人疾病複雜度高，發病症狀不具特異性，導致臨床醫師缺乏經驗與警覺心，未能及時診斷結核病，造成延遲治療與傳播風險。
為更積極推動防疫政策，本院組成核心工作小組，透過臨床決策支持系統(clinical decision support system; CDSS)，以使用抗腫瘤壞死因子阻斷劑者、血糖控制不佳的糖尿病病人、血液透析或腹膜透析病人、愛滋病毒感染者、器官移植者及65歲以上老年人等結核病發病之高風險族群為主要對象，規劃與建立「高風險族群胸部X光提示視窗」，並跨科部邀請相關科室分享門診特色與執行困難點，藉此凝聚共識，提升執行效能。期望透過臨床決策支持系統強化高風險族群結核病主動發現策略，及早發現感染源，阻斷傳播鏈，縮短疾病傳播時間。
結果：結核病高風險族群胸部X光檢查之主動發現策略的執行成效從76.6%上升到82.0%，不具執行成效則是由23.4%降至18.0%，皆達統計學上顯著差異(p <.001)。臨床決策支持系統可以協助臨床醫師，偵測符合高風險病人及主動提供結核病胸部X光篩檢服務。

Tuberculosis (TB) remains an important communicable disease globally. Considering the death, suffering and diseases caused by TB, WHO proposes in 2014 to“end the global TB epidemic”by 2035. On the other hand, the decreasing incidence of TB and the increased comorbidities of patients lead to the difficulty for the primary care physicians in early diagnosis of active TB, which may delay the treatment and increase the risk of disease transmission.
Thus, the TB control team, in a tertiary care hospital in Taiwan, aim to use clinical decision support system (CDSS) to actively screen high risk patient groups for TB (eg: > 65 years-old, HIV, receiving tumor necrosis factor alpha (TNF-α) inhibitors, hemodialysis, solid organ transplantation, poor DM control). We developed the chest X-ray reminding window for high risk TB groups in the outpatient clinic system (OPD) and invite the involved department to clarify the patients identify method and resolve possible hinders.
The“chest X-ray reminding window”for high risk TB group started since April 10, 2021 and we compare the performance between lead-in phase (April 10, 2021 to Dec. 31, 2021) and the maintenance phase (Jan. 1, 2022 to Sep 30, 2022). There were total 38,724 events had the pup-up reminding during the OPD visit. The percentage of physicians respond to the reminding window increased from 76.6% in lead-in phase to 82.0% in maintenance phase (p<.001).
The CDSS can help in patients fulfill the risk criteria and facilitate the primary care physicians to provide active screening for patients with high risk for active TB.