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A single-center model for implementation of SLEDAI documentation adherence in childhood-onset systemic lupus
Meghan Corrigan Nelson1,2, Colleen Mosley2, Tonya Bennett2
1Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Insights
Improving Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) documentation in pediatric patients is crucial. Clinical decision support reminders significantly increased physician adherence, overcoming barriers like forgetfulness and time constraints.
Area of Science:
- Pediatric Rheumatology
- Autoimmune Diseases
- Clinical Informatics
Background:
- Childhood-onset systemic lupus erythematosus (cSLE) is a serious autoimmune condition.
- Routine monitoring using indices like SLEDAI is recommended but often poorly adhered to.
- Physician adherence to SLEDAI documentation is a challenge in academic centers.
Purpose of the Study:
- To determine baseline SLEDAI documentation rates in pediatric SLE patients.
- To assess the impact of electronic clinical decision support (CDS) reminders on SLEDAI documentation adherence.
- To identify barriers to SLEDAI documentation.
Main Methods:
- Review of 1980 SLE encounters over 24 months at a pediatric academic center.
- Implementation of monthly email reminders and EMR-based CDS alerts (prompted by anti-dsDNA results).
- Continuous chart review and monthly feedback to providers; post-intervention provider survey.
Main Results:
- Baseline SLEDAI documentation was 10%.
- Monthly emails increased rates to 55%.
- Electronic in-basket reminders further increased rates to 60%; forgetfulness and lack of time were key barriers.
Conclusions:
- Monthly email reminders and EMR-integrated CDS alerts effectively improve SLEDAI documentation rates.
- Addressing physician-reported barriers like forgetfulness and time is essential for sustained adherence.
- Enhanced documentation supports better monitoring and management of pediatric SLE.
Background:
Childhood-onset systemic lupus erythematosus (cSLE) is an autoimmune disease with variable disease expression but noted association with significant disease-related damage, morbidity, and mortality. The European Alliance of Associations for Rheumatology (EULAR) recommends routine monitoring of SLE through validated disease activity and chronicity indices, including the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Despite this, physician adherence with SLEDAI documentation remains elusive at various academic institutions. The aim of our study was to determine baseline SLEDAI documentation rates at our center and assess the change in adherence in SLEDAI documentation rate with electronic clinical decision support (CDS) reminders facilitated through the electronic medical record (EMR) over a 2-year period.
Methods:
All SLE encounters over a 24-month period at a pediatric academic center were reviewed in order to obtain baseline SLEDAI documentation percentages. Physicians subsequently received monthly email reminders, initiated at month 4 of project initiation, with subsequent CDS reminder 13 months after project initiation prompted by anti-dsDNA lab result. Chart review was repeated continuously for each provider, and SLEDAI documentation rates were emailed to each provider monthly. Physicians completed a post-intervention survey regarding barriers to SLEDAI documentation at the end of the study.
Results:
A total of 1980 SLE encounters were reviewed for this study. Baseline SLEDAI documentation rates were 10%. Following the introduction of monthly emails reminding physicians to document SLEDAI, rates increased to 55%. After the initiation of electronic in-basket reminders prompted by lab results, rates increased to 60%. Noted barriers to documentation were cited to be forgetfulness (67%) and lack of time (33%).
Conclusion:
Our study demonstrates that monthly email reminders as well as EMR-mediated electronic in-basket reminders increased SLEDAI documentation rates at an academic center. Noted barriers to documentation were reported to be forgetfulness (67%) and lack of time (33%).
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