Pediatric Health, Medicine and Therapeutics (Jul 2020)
Implementation of Electronic Medical Record Template Improves Screening for Complications in Children with Type 1 Diabetes Mellitus
Abstract
Deepak Choudhary,1 Brande Brown,2 Nayaab Khawar,2 Pramod Narula,2 Levon Agdere2 1Department of Pediatrics Emergency Medicine, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AR 72202, USA; 2New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USACorrespondence: Brande BrownNew York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USATel +1 718-780-5260Email [email protected]: Health professionals and patients should follow comprehensive screening guidelines to recognize early signs of long-term complications for insulin-dependent type 1 diabetes mellitus (T1DM). The aim of this study is to demonstrate that utilization of electronic medical record (EMR) templates for diabetes management improves adherence to International Society for Pediatric and Adolescent Diabetes (ISPAD) screening guidelines.Methods: All patients with T1DM who were seen in the outpatient pediatric endocrine clinic (age 0– 22 years old) at an urban community-based community hospital during the 2014 calendar year were enrolled in the study (n=49). A retrospective chart review was performed and audited against ISPAD guidelines. An EMR template and order set was then created based on ISPAD screening guidelines with the aim of improving compliance. The templates were implemented in 2015 (initial phase) and 2016 (maintenance phase) and these data were compared to baseline data. A chi-squared test was performed to analyze the differences between the data using SAS version 9.4 (SAS Institute, Inc). A p-value less than 0.05 was considered significant.Results: Significant improvements (p< 0.05) in screening guideline adherence from baseline to maintenance phase data were found for annual retinopathy (0% to 45%) and neuropathic foot (0% to 64%) exams, screening for microalbuminuria (49% to 79%), celiac disease (6% to 81%), lipids (63% to 86%), and basic metabolic panel (69% to 88%). Of note, thyroid function testing was also increased, but was not statistically significant between the years.Conclusion: The utilization of EMR templates and order sets for T1DM are valuable tools to aid medical providers in adhering to ISPAD screening guideline.Keywords: type 1 diabetes, electronic medical record, screening tool, disease management, chronic disease, benchmarking, quality improvement, pediatrics, standardized documentation
