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Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management

(1) Background: Clinical decision support (CDS) is a vitally important adjunct to the implementation of pharmacogenomic-guided prescribing in clinical practice. A novel CDS was sought for the APOL1, NAT2, and YEATS4 genes to guide optimal selection of antihypertensive medications among the African A...

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Autores principales: Schneider, Thomas M., Eadon, Michael T., Cooper-DeHoff, Rhonda M., Cavanaugh, Kerri L., Nguyen, Khoa A., Arwood, Meghan J., Tillman, Emma M., Pratt, Victoria M., Dexter, Paul R., McCoy, Allison B., Orlando, Lori A., Scott, Stuart A., Nadkarni, Girish N., Horowitz, Carol R., Kannry, Joseph L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226809/
https://www.ncbi.nlm.nih.gov/pubmed/34071920
http://dx.doi.org/10.3390/jpm11060480
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author Schneider, Thomas M.
Eadon, Michael T.
Cooper-DeHoff, Rhonda M.
Cavanaugh, Kerri L.
Nguyen, Khoa A.
Arwood, Meghan J.
Tillman, Emma M.
Pratt, Victoria M.
Dexter, Paul R.
McCoy, Allison B.
Orlando, Lori A.
Scott, Stuart A.
Nadkarni, Girish N.
Horowitz, Carol R.
Kannry, Joseph L.
author_facet Schneider, Thomas M.
Eadon, Michael T.
Cooper-DeHoff, Rhonda M.
Cavanaugh, Kerri L.
Nguyen, Khoa A.
Arwood, Meghan J.
Tillman, Emma M.
Pratt, Victoria M.
Dexter, Paul R.
McCoy, Allison B.
Orlando, Lori A.
Scott, Stuart A.
Nadkarni, Girish N.
Horowitz, Carol R.
Kannry, Joseph L.
author_sort Schneider, Thomas M.
collection PubMed
description (1) Background: Clinical decision support (CDS) is a vitally important adjunct to the implementation of pharmacogenomic-guided prescribing in clinical practice. A novel CDS was sought for the APOL1, NAT2, and YEATS4 genes to guide optimal selection of antihypertensive medications among the African American population cared for at multiple participating institutions in a clinical trial. (2) Methods: The CDS committee, made up of clinical content and CDS experts, developed a framework and contributed to the creation of the CDS using the following guiding principles: 1. medical algorithm consensus; 2. actionability; 3. context-sensitive triggers; 4. workflow integration; 5. feasibility; 6. interpretability; 7. portability; and 8. discrete reporting of lab results. (3) Results: Utilizing the principle of discrete patient laboratory and vital information, a novel CDS for APOL1, NAT2, and YEATS4 was created for use in a multi-institutional trial based on a medical algorithm consensus. The alerts are actionable and easily interpretable, clearly displaying the purpose and recommendations with pertinent laboratory results, vitals and links to ordersets with suggested antihypertensive dosages. Alerts were either triggered immediately once a provider starts to order relevant antihypertensive agents or strategically placed in workflow-appropriate general CDS sections in the electronic health record (EHR). Detailed implementation instructions were shared across institutions to achieve maximum portability. (4) Conclusions: Using sound principles, the created genetic algorithms were applied across multiple institutions. The framework outlined in this study should apply to other disease-gene and pharmacogenomic projects employing CDS.
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spelling pubmed-82268092021-06-26 Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management Schneider, Thomas M. Eadon, Michael T. Cooper-DeHoff, Rhonda M. Cavanaugh, Kerri L. Nguyen, Khoa A. Arwood, Meghan J. Tillman, Emma M. Pratt, Victoria M. Dexter, Paul R. McCoy, Allison B. Orlando, Lori A. Scott, Stuart A. Nadkarni, Girish N. Horowitz, Carol R. Kannry, Joseph L. J Pers Med Article (1) Background: Clinical decision support (CDS) is a vitally important adjunct to the implementation of pharmacogenomic-guided prescribing in clinical practice. A novel CDS was sought for the APOL1, NAT2, and YEATS4 genes to guide optimal selection of antihypertensive medications among the African American population cared for at multiple participating institutions in a clinical trial. (2) Methods: The CDS committee, made up of clinical content and CDS experts, developed a framework and contributed to the creation of the CDS using the following guiding principles: 1. medical algorithm consensus; 2. actionability; 3. context-sensitive triggers; 4. workflow integration; 5. feasibility; 6. interpretability; 7. portability; and 8. discrete reporting of lab results. (3) Results: Utilizing the principle of discrete patient laboratory and vital information, a novel CDS for APOL1, NAT2, and YEATS4 was created for use in a multi-institutional trial based on a medical algorithm consensus. The alerts are actionable and easily interpretable, clearly displaying the purpose and recommendations with pertinent laboratory results, vitals and links to ordersets with suggested antihypertensive dosages. Alerts were either triggered immediately once a provider starts to order relevant antihypertensive agents or strategically placed in workflow-appropriate general CDS sections in the electronic health record (EHR). Detailed implementation instructions were shared across institutions to achieve maximum portability. (4) Conclusions: Using sound principles, the created genetic algorithms were applied across multiple institutions. The framework outlined in this study should apply to other disease-gene and pharmacogenomic projects employing CDS. MDPI 2021-05-27 /pmc/articles/PMC8226809/ /pubmed/34071920 http://dx.doi.org/10.3390/jpm11060480 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schneider, Thomas M.
Eadon, Michael T.
Cooper-DeHoff, Rhonda M.
Cavanaugh, Kerri L.
Nguyen, Khoa A.
Arwood, Meghan J.
Tillman, Emma M.
Pratt, Victoria M.
Dexter, Paul R.
McCoy, Allison B.
Orlando, Lori A.
Scott, Stuart A.
Nadkarni, Girish N.
Horowitz, Carol R.
Kannry, Joseph L.
Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management
title Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management
title_full Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management
title_fullStr Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management
title_full_unstemmed Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management
title_short Multi-Institutional Implementation of Clinical Decision Support for APOL1, NAT2, and YEATS4 Genotyping in Antihypertensive Management
title_sort multi-institutional implementation of clinical decision support for apol1, nat2, and yeats4 genotyping in antihypertensive management
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226809/
https://www.ncbi.nlm.nih.gov/pubmed/34071920
http://dx.doi.org/10.3390/jpm11060480
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