Successful deployment of drug-disease interaction clinical decision support across multiple Kaiser Permanente regions.

OBJECTIVE: The study sought to develop a criteria-based scoring tool for assessing drug-disease knowledge base content and creation of a subset and to implement the subset across multiple Kaiser Permanente (KP) regions. MATERIALS AND METHODS: In Phase I, the scoring tool was developed, used to create a drug-disease alert subset, and validated by surveying physicians and pharmacists from KP Northern California. In Phase II, KP enabled the alert subset in July 2015 in silent mode to collect alert firing rates and confirmed that alert burden was adequately reduced. The alert subset was subsequently rolled out to users in KP Northern California. Alert data was collected September 2015 to August 2016 to monitor relevancy and override rates. RESULTS: Drug-disease alert scoring identified 1211 of 4111 contraindicated drug-disease pairs for inclusion in the subset. The survey results showed clinician agreement with subset examples 92.3%-98.5% of the time. Postsurvey adjustments to the subset resulted in KP implementation of 1189 drug-disease alerts. The subset resulted in a decrease in monthly alerts from 32 045 to 1168. Postimplementation monthly physician alert acceptance rates ranged from 20.2% to 29.8%. DISCUSSION: Our study shows that drug-disease alert scoring resulted in an alert subset that generated acceptable interruptive alerts while decreasing overall potential alert burden. Following the initial testing and implementation in its Northern California region, KP successfully implemented the disease interaction subset in 4 regions with additional regions planned. CONCLUSIONS: Our approach could prevent undue alert burden when new alert categories are implemented, circumventing the need for trial live activations of full alert category knowledge bases.

Is dental evaluation considered in unilateral maxillary sinusitis? A retrospective case series.

OBJECTIVE: Are patients with symptomatic unilateral maxillary sinusitis sent for a dental evaluation of odontogenic maxillary sinusitis (OMS)? PATIENTS AND METHODS: The medical records of all patients diagnosed with sinusitis at a university Ear-nose and throat (ENT) clinic from 2010 to 2015 were scrutinized for symptomatic unilateral maxillary sinusitis verified on CT. Any dental evaluation was recorded, as well as symptoms of OMS, duration to dental evaluation, diagnosis of OMS and dental treatment. RESULTS: A total of 1338 patients diagnosed with sinusitis were screened; 172 had unilateral maxillary sinusitis and 48% (82/172) OMS. 34% did not have any dental evaluation at all. Patients referred to local specialist dental care waited a median of 11 weeks for evaluation and a median of 15 weeks further for dental treatment. Symptoms more frequently reported in OMS patients were foul smell or taste (43.9% vs 11.1%, p < .0001), purulent rhinorrhea (40% vs 19.1%, p = .015) than non-OMS patients. The OMS group also reported more frequently that they were active smokers (31.7% vs 10%, p = .0005). CONCLUSIONS: OMS was found in 48% of unilateral maxillary sinusitis and one-third of the patients with unilateral maxillary sinusitis had no dental evaluation. Low awareness of OMS could delay diagnosis and treatment.