Increasing Diabetic Foot Exam Compliance through Documentation Mohammed Zare, MD, MS 1 ; Jennifer S. Lahue 2 ; Michelle R. Klawans, MPH 1, Kelley Carroll,

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Presentation transcript:

Increasing Diabetic Foot Exam Compliance through Documentation Mohammed Zare, MD, MS 1 ; Jennifer S. Lahue 2 ; Michelle R. Klawans, MPH 1, Kelley Carroll, MD 1 ; Brian Reed, MD 3 1 University of Texas Health Science Center at Houston, 2 Harris Health System, 3 Baylor College of Medicine Corresponding Author: Mohammed Zare, Introduction Annual diabetic foot exams are necessary in order to assess neuropathy, infection, ulceration, and circulation. The National Committee for Quality Assurance (NCQA) requires that 80% of diabetic patients receive an annual foot exam. However, gaps in the electronic medical record (EMR) often make it difficult to track documentation of foot exams. Harris County Health Clinics provide care to over 30,000 diabetic patients at 25 clinics annually. However, EPIC EMR only allowed for foot exams to be documented in text fields, and as result many diabetic patients did not receive annual exams. Methods The primary goal of this project was to ensure that all diabetic patients visiting Harris Health clinics received an annual foot exam, in line with NCQA and Medicare requirements. Creating an EPIC procedure that would remind physicians to complete the foot exam was determined to be a feasible way to increase compliance. IT technical analysts created a Health Maintenance reminder that would appear in patient’s charts when they needed a foot exam. A procedure note, containing the sensory, vascular, and visual field of the foot exam, was also added to the EMR. Once the foot exam was marked as complete in the EMR, a tracking code was sent to the Health Maintenance section to tell the system that the exam had been completed. Meetings were held with medical directors at all 25 clinics to show them the new EPIC procedure note, and get their feedback. The new EPIC procedure note on diabetic foot exams was added to the EMR in March Analyses Data on physician foot exam Health Maintenance compliance prior to Smart Phrase procedure implementation was collected on a small sample of diabetic patients from March 2013-February 2014 (n=5160). Data physician foot exam Health Maintenance compliance and Smart Phrase procedure compliance was collected from all diabetic patients from March 2014-February 2015 (n=32,396). Additionally, food exam compliance rates for all 35,841 diabetic patients seen between November 2015 and March 2016 were tracked. Frequentist statistics were used to determine the compliance rate along with any significant change between the two time periods. Results During the year prior to implementation, 4,568 out of the 5,160 patients who received a foot exam had the exam documented correctly in their chart. (89%) During the year following implementation, 29,367 out of all 32,396 diabetic patients who had a foot exam had the exam recorded correctly in their chart (91%). An independent two-sample t-test revealed that this increase was significant at the p<0.001 level. From November 2015 to March 2016, the compliance rate for diabetic foot exams rose from 64% to 73%. Introducing an EPIC Smart Phrase for Diabetic Foot Exams led to a significant increase in the percentage of physicians correctly documenting the foot exam. Following the introduction of the foot exam Smart Phrase, overall monthly diabetic foot exam compliance rates increased from 64% to 73%. In the Harris County Health system, introducing an EPIC Smart Phrase in order to prompt physicians to complete and document diabetic foot exams for all diabetic patients was a feasible and acceptable way to increase compliance and raise completion rates. EPIC Smart Phrases may be a technology-based intervention method for increasing compliance rates for other required Medicare procedures. Conclusions Figure 3: Foot Exam Compliance Rates (N=35,481) * Figure 1: EPIC Procedure Figure 2: Documentation Compliance in Health Maintenance and Smart Phrase * Significant at p<0.05 Acknowledgements The authors would like to thank the faculty and staff of the McGovern Medical School Department of Family and Community Medicine and the Harris County Health System. The authors have no conflicts of interest to disclose. References available upon request from the corresponding author.