Improving the Diagnosis of Menstrual Dysfunction through Quality Improvement

Area of Science:

• Sports Medicine
• Pediatrics
• Quality Improvement Science

Background:

• Menstrual dysfunction (MD) affects 7-54% of high school athletes, necessitating early detection.
• Untreated MD can lead to significant long-term health consequences.
• Pediatric sports medicine clinics are key sites for identifying and managing MD in young athletes.

Purpose of the Study:

• To enhance the Epic Best Practice Advisory (BPA) screening tool for diagnosing MD in athletes over 12.
• To integrate new patient questionnaires for improved MD diagnosis.
• To optimize the identification and management of menstrual dysfunction in a pediatric sports medicine setting.

Main Methods:

• Quality Improvement methodology and Plan-Do-Study-Act cycles were employed.
• Clinic workflow, the Epic BPA tool, and physician actions were evaluated.
• Interventions included staff/patient education and BPA alert optimization.

Main Results:

• The rate of appropriate MD diagnosis in athletes aged >12 increased from 2.1% to 30% over ten months.
• Successful identification and intervention were driven by three key factors.
• Optimized screening and diagnostic tools led to a substantial increase in MD diagnosis.

Conclusions:

• Quality Improvement initiatives effectively optimized the Epic BPA tool, increasing MD diagnosis rates.
• Improved diagnosis facilitates better patient education and timely intervention.
• This project established a framework for discussing, intervening, and working up at-risk athletes for MD.