Takahiro Soda1, Jennifer Richards1, Bradley N Gaynes1, Michelle Cueva1, Jeffrey Laux1, Christine McClain1, Rachel Frische1, Lisa K Lindquist1, Gary S Cuddeback1, L Fredrik Jarskog1. 1. Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist).
Abstract
OBJECTIVE: The authors sought to increase the rate of cardiometabolic monitoring for patients receiving antipsychotic drugs in an academic outpatient psychiatric clinic serving people with serious mental illness. METHODS: Using a prospective quasi-experimental, interrupted time-series design with data from the electronic health record (EHR), the authors determined metabolic monitoring rates before, during, and after implementation of prespecified quality improvement (QI) measures between August 2016 and July 2017. QI measures included a combination of provider, patient, and staff education; systematic barrier reduction; and an EHR-based reminder system. RESULTS: After 1 year of QI implementation, the rate of metabolic monitoring had increased from 33% to 49% (p<0.01) for the primary outcome measure (hemoglobin A1C and lipid panel). This increased monitoring rate was sustained for 27 months beyond the end of the QI intervention. More than 75% of providers did not find the QI reminders burdensome. CONCLUSIONS: Significant improvement in the rate of metabolic monitoring for people taking antipsychotic drugs can be achieved with little added burden on providers. Future research needs to assess the full range of patient, provider, and system barriers that prevent cardiometabolic monitoring for all individuals receiving antipsychotic drugs.
OBJECTIVE: The authors sought to increase the rate of cardiometabolic monitoring for patients receiving antipsychotic drugs in an academic outpatient psychiatric clinic serving people with serious mental illness. METHODS: Using a prospective quasi-experimental, interrupted time-series design with data from the electronic health record (EHR), the authors determined metabolic monitoring rates before, during, and after implementation of prespecified quality improvement (QI) measures between August 2016 and July 2017. QI measures included a combination of provider, patient, and staff education; systematic barrier reduction; and an EHR-based reminder system. RESULTS: After 1 year of QI implementation, the rate of metabolic monitoring had increased from 33% to 49% (p<0.01) for the primary outcome measure (hemoglobin A1C and lipid panel). This increased monitoring rate was sustained for 27 months beyond the end of the QI intervention. More than 75% of providers did not find the QI reminders burdensome. CONCLUSIONS: Significant improvement in the rate of metabolic monitoring for people taking antipsychotic drugs can be achieved with little added burden on providers. Future research needs to assess the full range of patient, provider, and system barriers that prevent cardiometabolic monitoring for all individuals receiving antipsychotic drugs.
Entities:
Keywords:
Antipsychotics; Laboratory testing; Metabolic side effects; Quality improvement; Serious mental illness. Electronic health record
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