Initial trial of an electronic dashboard to improve dosing of hydroxychloroquine within the VA healthcare system: Time series analysis (Preprint)

BACKGROUND Hydroxychloroquine (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. OBJECTIVE We developed and piloted an EHR-based dashboard to improve safe prescribing of HCQ within the Veterans Health Administration (VHA). We observed pilot facilities over a one-year period to determine whether they were able to improve the proportion of patients receiving inappropriate doses of HCQ. METHODS Patients receiving HCQ were identified from the VHA Corporate Data Warehouse. Using PowerBI (Microsoft), we constructed a dashboard to display patient identifiers and most recent HCQ dose and weight (flagged if ≥ 5.2mg/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 ≥ 5.2mg/kg/day between October 2020 to November 2021. RESULTS We identified 18,190 total users of HCQ nationwide in the VHA, including 1,276 patients at the 6 pilot facilities. Nationwide at baseline, 20.6% of patients were receiving high doses of HCQ. We observed significant improvements in the proportion of HCQ prescribed at doses ≥ 5.2mg/kg/day among pilot facilities after the dashboard was deployed (-0.06, 95% CI (-0.08, -0.04)). The difference in the post-intervention linear trend for pilot vs. synthetic controls was also significant (-0.06, 95%CI (-0.08, -0.05)). CONCLUSIONS Use of an EHR-based dashboard reduced the proportion of patients receiving higher than recommended doses of HCQ and significantly improved performance at six VHA facilities. National roll-out of the dashboard will enable further improvements in safe prescribing of HCQ. CLINICALTRIAL