Division of Gastroenterology and Hepatology, Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
Internal Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
BMJ Open Qual. 2023 Feb;12(1). doi: 10.1136/bmjoq-2022-002008.
Studies have shown that patients with inflammatory bowel disease (IBD) do not receive age appropriate preventive care services at the same rate as the general population. Providers extract information on preventive measures compliance by chart review, discussion with patients or deferment to primary care providers to ensure and document compliance. The aim of this pilot study was to evaluate the effectiveness of our standardised template which was incorporated in the electronic health records in order to provide the highest quality of clinical care and improve efficiency. We compared the outcomes before and after implementation of the template. In our preimplementation phase, we performed retrospective single-centre chart review of all patients diagnosed with IBD and treated with an immune modulator therapy between years January 2015-December 2016 and December 2019-July 2020. Preventive care measures included influenza and pneumonia, smoking cessation, checking thiopurine methyltransferase (TPMT) enzyme activity prior to starting thiopurines, screening for hepatitis B status, and tuberculosis (TB) testing prior to starting anti-TNF therapy. A total of 200 patients were included. Prior to the template implementation, manual extraction of data showed about 43% and 31% of the patients with IBD received influenza vaccination in 2015 and 2016, respectively. There were 40.9% who received pneumococcal vaccination, 57.5% with TPMT activity prior to thiopurine use, 60% had hepatitis B testing and only 12.5% had documented TB test. Post intervention, there was a significant increase in vaccination rates with 93.1% and 87.6% received influenza and pneumococcal vaccination, respectively (p<0.0005). About 94.7% had TPMT activity, 96.8% had hepatitis B and 98.9% had TB test completed (p<0.0005). The average time (minutes) to obtain information for each patient decreased from 12.27 to 4.62. Our study demonstrated a significant improvement in documented immunisation rates and quality of preventive care after implementation of standardised template.
研究表明，炎症性肠病（IBD）患者接受预防保健服务的比例与普通人群不同，且未达到相应年龄应有的水平。医生通过病历回顾、与患者讨论或委托初级保健提供者来获取预防措施的执行情况信息，以确保并记录预防措施的执行情况。本研究旨在评估我们标准化模板的有效性，该模板已纳入电子健康记录，以提供最高质量的临床护理并提高效率。我们比较了模板实施前后的结果。在我们的实施前阶段，我们对 2015 年 1 月至 2016 年 12 月和 2019 年 12 月至 2020 年 7 月期间在我院接受免疫调节剂治疗的所有 IBD 患者进行了回顾性单中心病历回顾。预防保健措施包括流感和肺炎疫苗接种、戒烟、开始使用硫嘌呤前检查硫嘌呤甲基转移酶（TPMT）酶活性、乙型肝炎状态筛查和开始使用抗 TNF 治疗前进行结核（TB）检测。共纳入 200 例患者。在模板实施之前，手动提取数据显示，2015 年和 2016 年分别有 43%和 31%的 IBD 患者接受了流感疫苗接种。有 40.9%的患者接受了肺炎球菌疫苗接种，57.5%的患者在使用硫嘌呤前进行了 TPMT 活性检查，60%的患者进行了乙型肝炎检测，仅有 12.5%的患者进行了 TB 检测。干预后，流感和肺炎疫苗接种率显著提高，分别为 93.1%和 87.6%（p<0.0005）。约 94.7%的患者进行了 TPMT 活性检查，96.8%的患者进行了乙型肝炎检测，98.9%的患者完成了 TB 检测（p<0.0005）。每位患者获取信息的平均时间（分钟）从 12.27 分钟减少到 4.62 分钟。本研究表明，实施标准化模板后，免疫接种记录和预防保健质量显著提高。
