Robbins Calvin C, Anjum Sidrah, Alwreikat Amer Mosa, Cooper Michael Lee, Cotran Paul R, Roh Shiyoung, Ramsey David J
Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, Massachusetts.
Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts.
Ophthalmol Sci. 2021 Sep 22;1(4):100059. doi: 10.1016/j.xops.2021.100059. eCollection 2021 Dec.
This study describes the implementation of an electronic medical record (EMR)-based initiative aimed at reducing the number of patients with glaucoma-related diagnoses lost to follow-up (LTF) and reviews its short-term outcomes.
Retrospective, comparative case series.
Patients with glaucoma-related diagnoses seen 1 year prior at the Lahey Medical Center and who had not returned within the 6-month period between January 1, 2020, and June 30, 2020, which spanned the outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic in the United States.
An EMR-based tool was designed to identify patients suspected of being LTF with glaucoma-related diagnoses. Providers were enlisted to review the EMR for each of these patients and re-engage them, as appropriate. One month later, the initiative was evaluated by means of a retrospective chart review. Binary logistic regression analysis was used to identify demographic, clinical, and sociomedical factors associated with being LTF.
Patients who completed a telemedicine or in-person appointment, or had a future scheduled or ordered return appointment, were considered re-engaged.
Of the 3551 patients seen during the study period, 384 patients were identified as LTF (11%), with 60 identifying COVID-19 as the reason for canceling their visit (16%). Patients who lived farther from the eye clinic ( 0.001) or who had a history of canceling or missing an appointment ( 0.001) were more likely to be LTF. Patients with open-angle glaucoma ( 0.042) or who had completed a visual field ( 0.001) or ophthalmic imaging ( 0.001) within the past year were less likely to be LTF. One month after the re-engagement initiative, 124 LTF patients (32%) had been re-engaged (40% through telemedicine), 238 patients (62%) had future scheduling orders in place, and 22 patients (6%) had no active plan for future follow-up.
An EMR-based tool is an effective method for identifying patients at risk of being LTF and provides an opportunity for providers to recall and re-engage patients. Use of telemedicine to recontact LTF patients shows promise of improving the management of glaucoma, enhancing clinical productivity, and documenting treatment plans, thereby potentially reducing medicolegal liability.
本研究描述了一项基于电子病历（EMR）的举措的实施情况，该举措旨在减少青光眼相关诊断失访（LTF）患者的数量，并回顾其短期结果。
回顾性、比较性病例系列研究。
在Lahey医疗中心就诊过且在2020年1月1日至2020年6月30日这6个月期间未复诊的青光眼相关诊断患者，该时间段涵盖了美国2019冠状病毒病（COVID-19）大流行的爆发期。
设计了一种基于EMR的工具来识别疑似青光眼相关诊断失访的患者。招募医疗服务提供者对这些患者中的每一位进行EMR回顾，并在适当的时候重新联系他们。1个月后，通过回顾性病历审查对该举措进行评估。使用二元逻辑回归分析来确定与失访相关的人口统计学、临床和社会医学因素。
完成远程医疗或面对面预约、或有未来预约安排或已下达复诊医嘱的患者被视为重新参与随访。
在研究期间就诊的3551名患者中，有384名患者被确定为失访（11%），其中60名患者将COVID-19作为取消就诊的原因（16%）。居住距离眼科诊所较远（P<0.001）或有取消或错过预约病史（P<0.001）的患者更有可能失访。开角型青光眼患者（P = 0.042）或在过去一年中完成过视野检查（P<0.001）或眼科成像检查（P<0.001）的患者失访的可能性较小。重新参与随访举措实施1个月后，124名失访患者（32%）已重新参与随访（40%通过远程医疗），238名患者（62%）有未来预约安排，22名患者（6%）没有未来随访的积极计划。
基于EMR的工具是识别有失访风险患者的有效方法，为医疗服务提供者召回并重新联系患者提供了机会。使用远程医疗重新联系失访患者有望改善青光眼的管理、提高临床工作效率并记录治疗计划，从而可能减少医疗法律责任。
