Effect of Implementing a Dashboard With or Without a Best Practice Alert on HLA-B*58:01 Testing Rates Among Allopurinol Users at VA Medical Centers.

Abstract

The American College of Rheumatology recommends HLA-B*58:01 allele testing before the initiation of allopurinol, specifically among Asian and African American/Black patients, due to their increased risk for severe hypersensitivity reactions. However, testing rates remain low at many health care facilities. This study aimed to determine whether the introduction of a clinician-facing dashboard, with or without a best practice alert (BPA), would increase HLA-B*58:01 testing rates among eligible patients at two VA medical centers. In October 2022, we launched a clinician-facing dashboard that displayed HLA-B*58:01 testing results for all patients prescribed allopurinol at two VA medical centers. In January 2023, we added a synchronous BPA that appeared at one of the two medical centers whenever a provider entered a prescription for allopurinol. The BPA was presented as blue text on the medication order entry form and stated "HLA-B*58:01 genotyping recommended before rx for Asian or African American." Using data from the electronic health record, we compared the change in proportion of patients receiving allopurinol prescriptions who had HLA-B*58:01 genotype testing done after implementation of the dashboard (±BPA) at the two VA medical centers. From October 2022 through December 2023, the number of Asian or African American/Black patients who filled one or more prescriptions for allopurinol was 262 at the BPA + dashboard site and 330 at the dashboard only site. The percentage of Asian or African American/Black patients who had HLA-B*58:01 testing before or during the month allopurinol was prescribed increased from 8.8% in October 2022 to 35.5% in December 2023 at the dashboard + BPA site and from 2.1% to 4.5% at the dashboard only site (P < 0.0001 for difference in difference). The cumulative percentage of prescribers whose patient(s) completed HLA-B*58:01 testing increased from 11.7% to 46.8% at the dashboard + BPA site and from 6.9% to 10.8% at the dashboard only site (P < 0.0001 for difference in difference). Implementing a dashboard plus simple text BPA was associated with a greater increase in the proportion of patients who completed guideline-recommend HLA-B*58:01 testing compared to implementing a dashboard alone.