Stephanie L Santoro1,2, Thomas Bartman3,2, Clifford L Cua3,2, Stephanie Lemle3, Brian G Skotko4,5. 1. Nationwide Children's Hospital, Columbus, Ohio; stephanielynnsantoro@gmail.com. 2. Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio. 3. Nationwide Children's Hospital, Columbus, Ohio. 4. Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; and. 5. Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts.
Abstract
OBJECTIVES: Established guidelines from the American Academy of Pediatrics for the care of patients with Down syndrome are often not followed. Our goal was to integrate aspects of the guidelines into the electronic health record (EHR) to improve guideline adherence throughout a child's life span. METHODS: Two methods of EHR integration with age-based logic were created and implemented in June 2016: (1) a best-practice advisory that prompts an order for referral to genetics; and (2) a health maintenance record that tracks completion of complete blood cell count and/or hemoglobin testing, thyrotropin testing, echocardiogram, and sleep study. Retrospective chart review of patients with Down syndrome and visits to locations with EHR integration (NICUs, primary care centers, and genetics clinics) assessed adherence to the components of EHR integration; the impact was analyzed through statistical process control charts. RESULTS: From July 2015 to October 2017, 235 patients with Down syndrome (ages 0 to 32 years) had 466 visits to the EHR integration locations. Baseline adherence for individual components ranged from 51% (sleep study and hemoglobin testing) to 94% (echocardiogram). EHR integration was associated with a shift in adherence to all select recommendations from 61.6% to 77.3% (P < .001) including: genetic counseling, complete blood cell count and/or hemoglobin testing, thyrotropin testing, echocardiogram, and sleep study. CONCLUSIONS: Integrating specific aspects of Down syndrome care into the EHR can improve adherence to guideline recommendations that span the life of a child. Future quality improvement should be focused on older children and adults with Down syndrome.
OBJECTIVES: Established guidelines from the American Academy of Pediatrics for the care of patients with Down syndrome are often not followed. Our goal was to integrate aspects of the guidelines into the electronic health record (EHR) to improve guideline adherence throughout a child's life span. METHODS: Two methods of EHR integration with age-based logic were created and implemented in June 2016: (1) a best-practice advisory that prompts an order for referral to genetics; and (2) a health maintenance record that tracks completion of complete blood cell count and/or hemoglobin testing, thyrotropin testing, echocardiogram, and sleep study. Retrospective chart review of patients with Down syndrome and visits to locations with EHR integration (NICUs, primary care centers, and genetics clinics) assessed adherence to the components of EHR integration; the impact was analyzed through statistical process control charts. RESULTS: From July 2015 to October 2017, 235 patients with Down syndrome (ages 0 to 32 years) had 466 visits to the EHR integration locations. Baseline adherence for individual components ranged from 51% (sleep study and hemoglobin testing) to 94% (echocardiogram). EHR integration was associated with a shift in adherence to all select recommendations from 61.6% to 77.3% (P < .001) including: genetic counseling, complete blood cell count and/or hemoglobin testing, thyrotropin testing, echocardiogram, and sleep study. CONCLUSIONS: Integrating specific aspects of Down syndrome care into the EHR can improve adherence to guideline recommendations that span the life of a child. Future quality improvement should be focused on older children and adults with Down syndrome.
Authors: Stephanie L Santoro; Ashlee Campbell; Clorinda Cottrell; Karen Donelan; Ben Majewski; Nicolas M Oreskovic; Vasiliki Patsiogiannis; Amy Torres; Brian G Skotko Journal: J Appl Res Intellect Disabil Date: 2021-03-23
Authors: Stephanie L Santoro; Diana Brenner-Miller; Clorinda Cottrell; Joy Bress; Amy Torres; Brian G Skotko Journal: Pediatr Qual Saf Date: 2021-09-24
Authors: Kristin M Jensen; Elizabeth J Campagna; Elizabeth Juarez-Colunga; Allan V Prochazka; Desmond K Runyan Journal: Am J Prev Med Date: 2020-11-12 Impact factor: 5.043
Authors: Philip D Knollman; Christine H Heubi; Susan Wiley; David F Smith; Sally R Shott; Stacey L Ishman; Jareen Meinzen-Derr Journal: Otolaryngol Head Neck Surg Date: 2020-09-15 Impact factor: 5.591