Sustained Improvement in Inflammatory Bowel Disease Quality Measures Using an Electronic Health Record Intervention

Andrew Bensinger; Farra Wilson; Patrick Green; Richard Bloomfeld; Ajay Dharod

doi:10.1055/s-0039-3400293

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2019; 10(05): 918-926
DOI: 10.1055/s-0039-3400293

Research Article

Georg Thieme Verlag KG Stuttgart · New York

Sustained Improvement in Inflammatory Bowel Disease Quality Measures Using an Electronic Health Record Intervention

Andrew Bensinger

¹Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States

,

Farra Wilson

²Department of Internal Medicine, Section on Gastroenterology, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States

,

Patrick Green

²Department of Internal Medicine, Section on Gastroenterology, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States

,

Richard Bloomfeld

²Department of Internal Medicine, Section on Gastroenterology, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States

,

Ajay Dharod

³Department of Internal Medicine, Section on General Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States

› Author Affiliations

Abstract

Background Inflammatory bowel disease (IBD) is a chronic condition with wide variation in treatment and resource utilization because of many different disease presentations and treatment options. In an effort to standardize care and improve health outcomes, several organizations have created performance measures to monitor various aspects of IBD care.

Objectives We aimed to assess longitudinal documentation adherence with physician quality reporting system's (PQRS) IBD performance measures before, immediately after, and 1 year following the implementation of a comprehensive electronic health record (EHR) IBD clinical documentation support tool intervention.

Methods We reviewed 50 patient charts that were randomly selected from consecutive outpatient IBD visits at our tertiary care center from September 1, 2015 to June 30, 2016, prior to implementation of an IBD-specific note template, order set, and patient education handout on September 1, 2016. Two additional cohorts of 50 patient charts were randomly selected from September 1, 2016 to June 30, 2017 and September 1, 2017 to June 30, 2018. These charts were reviewed to assess adherence of pertinent PQRS performance measures for outpatient IBD care. The project was deemed not human subjects research and received exempt approval by the Institutional Review Board (IRB#: IRB00040399).

Results The cohort immediately after the intervention showed significant increases in documentation rates of influenza immunization (19–59%, p < 0.001), pneumococcal immunizations (2–38%, p < 0.001), tobacco cessation (28.6–77.8%, p = 0.049), and proportion of all eligible measures (40.6–62.2%, p < 0.001) when compared with the preintervention group. Moreover, documentation rates were sustained in the 1-year follow-up group when compared with the postintervention group.

Conclusion A multifaceted, EHR focused approach can significantly and sustainably improve documentation of outpatient IBD quality measures.

Keywords

electronic health records - implementation - quality - note - order set

Full Text

References

References
1 Kappelman MD, Rifas-Shiman SL, Kleinman K. , et al. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol 2007; 5 (12) 1424-1429
2 Centers for Disease Control and Prevention. Inflammatory bowel disease is an expensive disease. Available at: https://www.cdc.gov/ibd/pdf/inflammatory-bowel-disease-an-expensive-disease.pdf . Accessed February 28, 2019
3 Esrailian E, Spiegel BMR, Targownik LE, Dubinsky MC, Targan SR, Gralnek IM. Differences in the management of Crohn's disease among experts and community providers, based on a national survey of sample case vignettes. Aliment Pharmacol Ther 2007; 26 (07) 1005-1018
4 Weaver KN, Kappelman MD, Sandler RS. , et al. Variation in care of inflammatory bowel diseases patients in Crohn's and Colitis Foundation of America Partners: role of gastroenterologist practice setting in disease outcomes and quality process measures. Inflamm Bowel Dis 2016; 22 (11) 2672-2677
5 Berry SK, Siegel CA, Melmed GY. Quality improvement initiatives in inflammatory bowel disease. Curr Gastroenterol Rep 2017; 19 (08) 41
6 Moody-Williams J, Yong P, Long T. Meaningful measures—November 2017. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/Meaningful-Measures-webinar-slides-11-30-17.pdf . Accessed February 28, 2019
7 McConnell R, Velayos F. The vanishing tide: as MACRA moves in, IBD quality measures move out. Available at: https://www.mdedge.com/gihepnews/article/156121/vanishing-tide-macra-moves-ibd-quality-measures-move-out . Accessed March 18, 2019
8 Feuerstein JD, Lewandowski JJ, Martinez-Vazquez M, Leffler DA, Cheifetz AS. Documented compliance with inflammatory bowel disease quality measures is poor. Dig Dis Sci 2015; 60 (02) 339-344
9 Feuerstein JD, Castillo NE, Siddique SS. , et al. Poor documentation of inflammatory bowel disease quality measures in academic, community, and private practice. Clin Gastroenterol Hepatol 2016; 14 (03) 421-428
10 Greene L, Moreo K. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities. BMJ Qual Improv Rep 2015; 4 (01) u208829.w3554
11 Centers for Medicare and Medicaid Services. 2016 PQRS measures group specification manual. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/2016_PQRS_IndivMeasures_Guide_11_17_2015.pdf . Accessed February 28, 2019
12 Sapir T, Moreo K, Carter JD, Greene L, Patel B, Higgins PD. Continuing medical education improves gastroenterologists' compliance with inflammatory bowel disease quality measures. Dig Dis Sci 2016; 61 (07) 1862-1869
13 McBeth CL, Montes RS, Powne A, North SE, Natale JE. Interprofessional approach to the sustained reduction in ventilator-associated pneumonia in a pediatric intensive care unit. Crit Care Nurse 2018; 38 (06) 36-45
14 Russell TA, Chung H, Riad C. , et al. Sustaining improvement: implementation and spread of a surgical site infection bundle. Am Surg 2018; 84 (10) 1665-1669
15 Feuerstein JD, Papamichael K, Popejoy S. , et al. Targeted physician education and standardizing documentation improves documented reporting with inflammatory bowel disease quality measures in a large academic and private practice. Dig Dis Sci 2018; 63 (01) 36-45
16 Yarahuan JW, Billet A, Hron JD. A quality improvement initiative to decrease platelet ordering errors and a proposed model for evaluating clinical decision support effectiveness. Appl Clin Inform 2019; 10 (03) 505-512
17 Fargo EL, D'Amico F, Pickering A, Fowler K, Campbell R, Baumgartner M. Impact of electronic physician order-set on antibiotic ordering time in septic patients in the emergency department. Appl Clin Inform 2018; 9 (04) 869-874
18 Jacobs BR, Hart KW, Rucker DW. Reduction in clinical variance using targeted design changes in computerized provider order entry (CPOE) order sets: impact on hospitalized children with acute asthma exacerbation. Appl Clin Inform 2012; 3 (01) 52-63
19 Nichols KR, Petschke AL, Webber EC, Knoderer CA. Comparison of antibiotic dosing before and after implementation of an electronic order set. Appl Clin Inform 2019; 10 (02) 229-236
20 Agency for Healthcare Research and Quality. Overview of CDS five rights. Available at: https://healthit.ahrq.gov/ahrq-funded-projects/current-health-it-priorities/clinical-decision-support-cds/chapter-1-approaching-clinical-decision/section-2-overview-cds-five-rights . Accessed March 18, 2019