P-076 YI The Performance of an Electronic Interactive Flow Sheet to Improve Preventive Health Care in Inflammatory Bowel Disease Patients

Abstract

The chronic inflammatory status along with the immunosuppressive therapies frequently used to control inflammatory bowel disease (IBD), place patients at increased risk of infections, malignancies, and bone disease. Despite the recognition of such risks, patients with IBD frequently receive suboptimal preventive health care. In this study we present the performance of an interactive flow sheet built into the electronic medical records to provide reminders and facilitate documentation of the appropriate cancer screening, immunizations, bone care, and laboratory monitoring for patients with IBD seen in the outpatient gastroenterology clinics at University of Rochester Medical Center (URMC). Design: quality improvement study. We initially evaluated the performance of our practice in recommending/providing preventive health care to IBD patients. This was accomplished by collecting data pertaining to preventive health care on a randomly selected sample (n = 100) of IBD patients seen in outpatient GI clinics at URMC (Table 1). An interactive flow sheet was then created within the electronic medical records system used at URMC (EPIC) with the following sections: disease history, current therapy, previous therapy, smoking history, immunization, bone health, and cancer screening (Figure 1). The flow sheet allows adjusting recommendations based on the patient’s disease history and therapies. The completed flow sheet can be easily retrieved and edited as needed during subsequent clinic visits. In addition, smart phrases were created to import information from the flow sheet into the clinic note and facilitate documentation. Four months after implementation, data was collected on randomly selected IBD patients (n = 105) to evaluate the rates of compliance in recommending, providing, and documenting preventive health care, as well as the rates of utilizing the flow sheet. The flow sheet was completed on 36 out of 105 IBD patients evaluated post intervention (34.3%). The overall rate of documenting discussion and status of preventive health care (immunization, cancer screening, and bone health) increased from 6% to 39% after implementing the electronic flow sheet. The rates of immunization and/or recommending influenza and pneumonia vaccines have increased after implementing the flow sheet. Similarly, documenting the status of hepatitis B immunization among patients receiving anti-TNF therapies, documenting discussion of skin cancer risk in patients receiving immunomodulators, and providing vitamin D supplements when indicated have increased post-intervention. Recommending bone density testing when indicated has not improved. The evaluated indicators were up to date in all patients whose flow sheet was completed. 1. Implementation of the interactive IBD quality measure flow sheet improved documentation and rates of providing/discussing preventive health services. 2. Persistent low rate of recommending bone density testing when indicated possibly related to the fact that in the vast majority of patients, testing was indicated for age rather than steroid use with tendency to defer such recommendation to the primary care physician. 3. The flow sheet was completed on only one third of the patients, this was likely related to the diversity of clinical practices and increased volume load in the clinics. Providing periodic reminders and/or mandating the completion the flow sheet might further improve preventive health care in IBD patients.