School of Medicine and Health Sciences Poster Presentations
Improving Adherence to Screening and Immunization Guidelines Among Medical Residents in the Internal Medicine Clinic
Poster Number
287
Document Type
Poster
Publication Date
3-2016
Abstract
Purpose: Our goal was to improve adherence to The United States Preventive Services Task Force (USPSTF) screening and immunization guidelines among medical residents at the internal medicine clinic.
Methodology: Using the Abdominal Aortic Aneurysm(AAA) screening compliance rate as a surrogate marker for other screening and immunization compliance rates, we observed the screening rates within a group of 99 internal medicine residents. Baseline screening rates were obtained by reviewing medical records of patients who had received a health maintenance exam between June 23rd and August 22nd, 2015. We then introduced intervention methods with the intent to improve screening rates. For our first intervention, residents attended a short educational session, during which a primary care physician outlined the AAA screening recommendation. For the second intervention, an email was sent to all internal medicine residents to reinforce the AAA screening guideline. The third intervention involved sending an email to supervising attendings, informing them of the recommendation and the screening rate among their residents. They were also urged to remind their residents to perform AAA screening when indicated. At the end of each intervention period (each week-long cycle, totaling to 5), retrospective data, including the screening rate, were calculated and compared to both the baseline and prior week’s results using the Chi-square test. In our final intervention, we plan to work with the clinic’s information technology team to integrate all screening tests and immunization recommendations into the electronic health record.
Results: The initial AAA screening rate was 2.5% between June 23rd and August 22nd, 2015. Over the next five weeks, following the first intervention method, this rate improved significantly from 2.5% to 15% with a p-value < 0.01. We suspect that this was due to the fact that no previous AAA screening guideline lecture had been given. Conversely, topics such as mammography, colonoscopy, and Papanicolaou(Pap) smear screening have been taught consistently. During the next two interventions, the rates were 12.5% and 33.3%, with p-values of 0.48 and < 0.01, respectively. We suspect these results are due to the complexity of patient concerns, along with high patient volume, which can make it difficult for internal medicine residents to address all necessary screening tests. The final intervention is still underway.
Conclusions: Our quality improvement project examined the baseline AAA screening rate and the effectiveness of various educational and systemic interventions for improving these rates. Education proved to have a significant role in improving residents' adherence to screening guidelines. Another way to enhance guideline adherence is to incorporate the guidelines into the medical record software. Having a tab for “Screening/immunization” as a set of orders and as part of the patient’s “History and Physical Note” template can help physicians address these matters on a more consistent basis.
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Open Access
1
Improving Adherence to Screening and Immunization Guidelines Among Medical Residents in the Internal Medicine Clinic
Purpose: Our goal was to improve adherence to The United States Preventive Services Task Force (USPSTF) screening and immunization guidelines among medical residents at the internal medicine clinic.
Methodology: Using the Abdominal Aortic Aneurysm(AAA) screening compliance rate as a surrogate marker for other screening and immunization compliance rates, we observed the screening rates within a group of 99 internal medicine residents. Baseline screening rates were obtained by reviewing medical records of patients who had received a health maintenance exam between June 23rd and August 22nd, 2015. We then introduced intervention methods with the intent to improve screening rates. For our first intervention, residents attended a short educational session, during which a primary care physician outlined the AAA screening recommendation. For the second intervention, an email was sent to all internal medicine residents to reinforce the AAA screening guideline. The third intervention involved sending an email to supervising attendings, informing them of the recommendation and the screening rate among their residents. They were also urged to remind their residents to perform AAA screening when indicated. At the end of each intervention period (each week-long cycle, totaling to 5), retrospective data, including the screening rate, were calculated and compared to both the baseline and prior week’s results using the Chi-square test. In our final intervention, we plan to work with the clinic’s information technology team to integrate all screening tests and immunization recommendations into the electronic health record.
Results: The initial AAA screening rate was 2.5% between June 23rd and August 22nd, 2015. Over the next five weeks, following the first intervention method, this rate improved significantly from 2.5% to 15% with a p-value < 0.01. We suspect that this was due to the fact that no previous AAA screening guideline lecture had been given. Conversely, topics such as mammography, colonoscopy, and Papanicolaou(Pap) smear screening have been taught consistently. During the next two interventions, the rates were 12.5% and 33.3%, with p-values of 0.48 and < 0.01, respectively. We suspect these results are due to the complexity of patient concerns, along with high patient volume, which can make it difficult for internal medicine residents to address all necessary screening tests. The final intervention is still underway.
Conclusions: Our quality improvement project examined the baseline AAA screening rate and the effectiveness of various educational and systemic interventions for improving these rates. Education proved to have a significant role in improving residents' adherence to screening guidelines. Another way to enhance guideline adherence is to incorporate the guidelines into the medical record software. Having a tab for “Screening/immunization” as a set of orders and as part of the patient’s “History and Physical Note” template can help physicians address these matters on a more consistent basis.
Comments
Presented at: GW Research Days 2016