Department of Ophthalmology, Université de Montréal, Montreal, QC, Canada.
Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada.
Int Ophthalmol. 2024 Jun 22;44(1):254. doi: 10.1007/s10792-024-03194-7.
To assess the quality of hydroxychloroquine (HCQ)-induced retinopathy screening at a Canadian tertiary center, we concentrate on risk factor documentation within the electronic health record, in accordance with the 2016 AAO guidelines.
We performed a retrospective quality assessment study based on chart review of patients who underwent screening for HCQ-induced retinopathy at the Centre Hospitalier de l'Université de Montréal (CHUM) from 2016 to 2019. We evaluated four key risk factors for HCQ-induced retinopathy: daily dose, duration of use, renal disease, and tamoxifen use, using a three-tier grading system (ideal, adequate, inadequate) for documentation assessment. Pareto and root cause analyses were conducted to identify potential improvement solutions.
Documentation quality varied in our study: daily dosage was 33% ideal, 31% appropriate, and 36% inappropriate. Duration of use documentation was 75% ideal, 2% adequate, and 24% inadequate. Renal disease documentation was only 6% ideal, with 62% adequate and 32% of charts lacking any past medical history. Among women's charts, tamoxifen use wasn't documented at all, with 65% adequately documenting medication lists. Pareto analysis indicated that improving renal disease and tamoxifen documentation could reduce 64% of non-ideal records, and enhancing daily dose documentation could decrease this by up to 90%.
Accurate documentation of key risk factors is critical for HCQ-induced retinopathy screening, impacting both exam initiation and frequency. Our study identifies potential improvements in the screening process at the hospital, referring physician, and ophthalmologist levels. Implementing integrated pathways could enhance patient experience and screening effectiveness.
为了评估加拿大一家三级医疗机构中羟氯喹（HCQ）诱导性视网膜病变筛查的质量，我们根据 2016 年 AAO 指南，专注于电子健康记录中危险因素的记录情况。
我们进行了一项回顾性质量评估研究，对 2016 年至 2019 年期间在蒙特利尔大学医疗中心（CHUM）接受 HCQ 诱导性视网膜病变筛查的患者进行了病历回顾。我们使用三级评分系统（理想、充分、不充分）评估了四个与 HCQ 诱导性视网膜病变相关的关键危险因素：每日剂量、使用时间、肾脏疾病和他莫昔芬的使用情况。我们进行了帕累托和根本原因分析，以确定潜在的改进解决方案。
我们的研究显示，记录质量存在差异：每日剂量的记录有 33%是理想的，31%是充分的，36%是不充分的。使用时间的记录有 75%是理想的，2%是充分的，24%是不充分的。肾脏疾病的记录只有 6%是理想的，62%是充分的，32%的病历缺乏任何既往病史。在女性病历中，根本没有记录他莫昔芬的使用情况，只有 65%的病历充分记录了药物清单。帕累托分析表明，改进肾脏疾病和他莫昔芬的记录可以减少 64%的非理想记录，而增强每日剂量的记录可以将这一比例降低多达 90%。
准确记录关键危险因素对于 HCQ 诱导性视网膜病变筛查至关重要，这不仅影响检查的启动，也影响检查的频率。我们的研究确定了在医院、转诊医生和眼科医生层面上改进筛查流程的潜在方法。实施综合的途径可以改善患者的体验和筛查的效果。
