TY - JOUR
T1 - Utility of an Electronic Health Record Report to Identify Patients with Delays in Testing for Poorly Controlled Diabetes
AU - Schwartz, Jessica L.
AU - Duan, Daisy
AU - Maruthur, Nisa M.
AU - Pitts, Samantha I.
N1 - Publisher Copyright:
© 2022 The Joint Commission
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Background: Reducing hemoglobin A1c (HbA1c) is essential for patients with poorly controlled diabetes. However, delays in HbA1c testing are common, and incomplete electronic health record (EHR) reports hinder identification of patients who are overdue. This study sought to quantify how often an EHR report correctly identifies patients with HbA1c testing delays and to describe potential contributing factors. Methods: Using an EHR report, the researchers identified adult patients who had an HbA1c > 9.0% between October 2017 and March 2018 and a suspected delay (for example, another HbA1c had not resulted within six months). A retrospective chart review of 200 randomly selected records was performed to confirm delays in testing. Secondary measures were collected from 93 charts to evaluate associated factors. Results: A total of 685 patients with suspected delays were identified. On chart review (N = 200), 82.0% were confirmed. Nine percent of patients had a timely repeat result, but the result was not in a discrete field within the EHR. Another 8.5% were never expected to return. Among a subset of confirmed delays, patients often received lifestyle counseling, but less than half had documented discussions about repeat glycemic testing. Also, 74.2% had a timely follow-up appointment scheduled but the majority (85.5%) were missed. Conclusion: Most suspected delays in HbA1c testing were confirmed; however, a substantial minority were misclassified due to missing data or follow-up care outside the health system. Current solutions to improve data quality for HbA1c are labor intensive and highlight the need for better integration of health care data. Missed appointments were commonly noted among patients with delays in care and are a potential target for improvement.
AB - Background: Reducing hemoglobin A1c (HbA1c) is essential for patients with poorly controlled diabetes. However, delays in HbA1c testing are common, and incomplete electronic health record (EHR) reports hinder identification of patients who are overdue. This study sought to quantify how often an EHR report correctly identifies patients with HbA1c testing delays and to describe potential contributing factors. Methods: Using an EHR report, the researchers identified adult patients who had an HbA1c > 9.0% between October 2017 and March 2018 and a suspected delay (for example, another HbA1c had not resulted within six months). A retrospective chart review of 200 randomly selected records was performed to confirm delays in testing. Secondary measures were collected from 93 charts to evaluate associated factors. Results: A total of 685 patients with suspected delays were identified. On chart review (N = 200), 82.0% were confirmed. Nine percent of patients had a timely repeat result, but the result was not in a discrete field within the EHR. Another 8.5% were never expected to return. Among a subset of confirmed delays, patients often received lifestyle counseling, but less than half had documented discussions about repeat glycemic testing. Also, 74.2% had a timely follow-up appointment scheduled but the majority (85.5%) were missed. Conclusion: Most suspected delays in HbA1c testing were confirmed; however, a substantial minority were misclassified due to missing data or follow-up care outside the health system. Current solutions to improve data quality for HbA1c are labor intensive and highlight the need for better integration of health care data. Missed appointments were commonly noted among patients with delays in care and are a potential target for improvement.
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U2 - 10.1016/j.jcjq.2022.03.002
DO - 10.1016/j.jcjq.2022.03.002
M3 - Article
C2 - 35595653
AN - SCOPUS:85130338274
SN - 1553-7250
VL - 48
SP - 335
EP - 342
JO - Joint Commission Journal on Quality and Patient Safety
JF - Joint Commission Journal on Quality and Patient Safety
IS - 6-7
ER -